Low plasma levels of the protein pro-LL-37 as an early indication of severe disease in patients with chronic neutropenia

Chronic neutropenia comprises several different diseases that vary in degree of severity and management. We analysed the levels of the neutrophil-derived protein pro-LL-37 in plasma of patients with chronic neutropenia to assess whether it could be used to differentiate different categories of chronic neutropenia. All patients with severe congenital neutropenia were pro-LL-37 deficient. This was in contrast to patients with autoimmune or idiopathic neutropenia, who exhibited normal pro-LL-37 levels while patients with cyclic neutropenia displayed an oscillation of pro-LL-37 in plasma. Plasma levels of pro-LL-37 may thus prove useful for differential diagnosis of chronic neutropenia.     

12例发热伴血小板减少综合征并发自发性腹壁血肿患者临床特征分析

目的?分析12例发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome, SFTS）并发自发性腹壁血肿（spontaneous abdominal wall hematoma, SAWH）患者的临床特征、诊疗经过及预后,提高临床医生对SFTS 并发SAWH的认识。方法?收集2011年3月—2021年11月联勤保障部队第990医院信阳医疗区感染科收治的12例SFTS并发SAWH患者的临床资料和随访结果,并进行相关统计学分析。结果?12例患者中,男性2例,女性10例,平均年龄65.8岁,发病时间集中在5～10月,临床表现主要为发热,乏力,明显食欲减退,恶心、呕吐,腹部持续性疼痛,皮下淤血、瘀斑,血红蛋白进行性下降。12例患者中SFTS普通型2例、重型7例、危重型3例 。SAWH确诊时间均在SFTS病程的7～13 d,其中发生在极期8例、恢复期4例。12例患者中并发肺部感染10例,SAWH均发生在肺部感染后3～5 d。10例患者好转出院,2例患者死亡。结论?SAWH是SFTS少见并发症,多发生在重型和危重型患者的极期或恢复期,以腹部持续性疼痛,皮下淤血、瘀斑,HGB进行性下降为突出表现,及时CT检查可早期诊断,经内科综合治疗,总体预后良好。     

Outcomes out to 12 months after sequential use of high-dose tofacitinib following infliximab in acute severe ulcerative colitis

Acute severe colitis (ASUC) remains a significant cause of morbidity in up to 25% of patients with ulcerative colitis during their disease course. We present the outcomes out to 12 months following the use of high-dose tofacitinib, 10 mg three times daily (TDS), in patients with steroid and infliximab refractory ASUC. A total of 11 patients with ASUC who were treated with high-dose tofacitinib after failing sequential infliximab therapy between 2019 and 2021 were identified at an Australian tertiary centre. Ten of 11 patients demonstrated clinical and biochemical response to treatment during admission. Two of 11 patients required colectomy, one during the index admission and the other during re-admission 10 days after the index presentation. Nine of the initial responders had a median Mayo score of 1 (IQR 0–4) at both 6 and 12 months, and all remained colectomy-free out to 12 months. Neither venous thromboembolic events nor major infective complications were observed. Tofacitinib may be a safe and effective induction and maintenance agent in the treatment of steroid and infliximab refractory ASUC. Prospective studies with long-term follow-up are required to explore the use of tofacitinib in ASUC before it can be routinely recommended as salvage therapy.     

Impact of severe hypoglycaemia requiring hospitalization on mortality in people with type 1 diabetes: A national retrospective observational cohort study

Aims

To assess if the risk of all-cause mortality increases in people with type 1 diabetes (T1D) with increasing number of severe hypoglycaemia episodes requiring hospitalization.

Materials and methods

We conducted a national retrospective observational cohort study in people with T1D (diagnosed between 2000 and 2018). Clinical, comorbidity and demographic variables were assessed for impact on mortality for people with no, one, two and three or more episodes of severe hypoglycaemia requiring hospitalization. The time to death (all-cause mortality) from the timepoint of the last episode of severe hypoglycaemia was modelled using a parametric survival model.

Results

A total of 8224 people had a T1D diagnosis in Wales during the study period. The mortality rate (95% confidence interval [CI]) was 6.9 (6.1-7.8) deaths/ 1000 person-years (crude) and 15.31 (13.3-17.63) deaths/ 1000 person-years (age-adjusted) for those with no occurrence of severe hypoglycaemia requiring hospitalization. For those with one episode of severe hypoglycaemia requiring hospitalization the mortality rate (95% CI) was 24.9 (21.0-29.6; crude) and 53.8 (44.6-64.7) deaths/ 1000 person-years (age-adjusted), for those with two episodes of severe hypoglycaemia requiring hospitalization it was 28.0 (23.1-34.0; crude) and 72.8 (59.2-89.5) deaths/ 1000 person-years (age-adjusted), and for those with three or more episodes of severe hypoglycaemia requiring hospitalization it was 33.5 (30.0-37.3; crude) and 86.3 (71.7-103.9) deaths/ 1000 person years (age-adjusted; P < 0.001). A parametric survival model showed that having two episodes of severe hypoglycaemia requiring hospitalization was the strongest predictor for time to death (accelerated failure time coefficient 0.073 [95% CI 0.009-0.565]), followed by having one episode of severe hypoglycaemia requiring hospitalization (0.126 [0.036-0.438]) and age at most recent episode of severe hypoglycaemia requiring hospitalization (0.917 [0.885-0.951]).

Conclusions

The strongest predictor for time to death was having two or more episodes of severe hypoglycaemia requiring hospitalization.     

Association between migraine or severe headache and hypertension among US adults: A cross-sectional study

Background and aimsEpidemiological evidence of the association between migraines, severe headaches, and hypertension is contradictory. Hypertension is a critical risk factor for cardiovascular diseases. Migraine is a common neurological disease and a major cause of disability worldwide. Therefore, we aimed to investigate the relationship between migraine, severe headaches, and hypertension among US adults.Methods and resultsCross-sectional data from 5716 subjects were obtained from the National Health and Nutrition Examination Survey between 1999 and 2004. Weighted logistic regression models investigated the association between migraines, severe headaches, and hypertension. In total, 5716 subjects were enrolled in the present study, of whom 1134 (19.8%) had migraine or severe headaches. Participants with migraine were predominantly younger females and had a higher body mass index (BMI), lower educational level, lower dietary intake of potassium and calcium, lower serum levels of total cholesterol (TC), creatinine, and hemoglobin, as well as a higher estimated glomerular filtration rate (eGFR) (all P < 0.05). After fully adjusting for potential confounders, migraine or severe headaches were positively associated with hypertension (OR 1.25, 95% CI: 1.03–1.53).ConclusionOur study found a positive association between migraine, severe headaches, and hypertension. Further studies are needed to verify the causality of this association and elucidate the underlying mechanisms.     

米力农注射液治疗儿童先天性心脏病合并重症肺炎及心力衰竭的疗效与安全性的Meta分析

目的：系统评价米力农注射液治疗儿童先天性心脏病（CHD）合并重症肺炎及心力衰竭的疗效。方法：计算机检索PubMed、EMBase、the Cochrane Library、万方数据库、CBM、CNKI,收集有关应用米力农注射液治疗儿童CHD合并重症肺炎及心力衰竭的随机对照试验（对照组给予常规对症治疗+多巴胺注射液或洋地黄,试验组给予常规对症治疗+米力农注射液）,检索时限均为建库至2018年8月。由2名评价者独立选择文献、提取资料和评估方法学质量后,采用Rev Man 5.3软件进行Meta分析,并使用Jadad系统评价质量。结果：共纳入5项随机对照试验,共398例患儿。与对照组比较,试验组总有效率（OR=1.25,95%CI：1.13~1.37,P<0.01）、心率平稳时间（SMD=-1.28,95%CI：-1.65~-0.91,P<0.01）、呼吸或咳嗽症状平稳时间（SMD=-2.18,95%CI：-4.02~-0.34,P=0.02）和心功能指标（LVEF）改善情况（SMD=1.14,95%CI：0.66~1.62,P<0.01）均具有明显优势。两组不良反应发生率比较差异无统计学意义（OR=1.31,95%CI：0.57~3.03,P=0.53）。结论：米力农治疗小儿CHD合并重症肺炎及心力衰竭可较快改善临床症状与心功能,提高总有效率。但由于文献质量的局限性,仍需大样本双盲随机试验的证据支持     

喜炎平注射液联合比阿培南治疗重症肺炎的临床研究

目的 探讨喜炎平注射液联合比阿培南治疗重症肺炎的临床效果。方法 选取2019年3月—2022年3月天津市第五中心医院收治的118例重症肺炎患者,按随机数字表法将所有患者分成对照组和治疗组,每组各59例。对照组静脉滴注注射用比阿培南,每次将0.3g溶于100mL生理盐水中,滴注30～60min,2次/d。治疗组在对照组基础上静脉滴注喜炎平注射液,每次将500mg加入250mL生理盐水中,1次/d。两组连续治疗14d。观察两组的临床疗效和典型表现（发热、咳嗽、胸闷痛、肺部啰音、白细胞异常）消失时间。比较治疗前后两组临床肺部感染评分（CPIS）、急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及血清C反应蛋白（CRP）、降钙素原（PCT）、可溶性细胞间黏附分子-1（sICAM-1）、白细胞介素（IL）-17、基质金属蛋白酶-9（MMP-9）水平。结果 治疗后,治疗组总有效率为93.2%,显著高于对照组的81.4%（P＜0.05）。治疗后,治疗组发热、咳嗽、胸闷痛、肺部啰音、白细胞异常的消失时间均较对照组显著缩短（P＜0.05）。治疗后,两组CPIS评分和APACHEⅡ评分均较治疗前显著降低（P＜0.05）;且均以治疗组下降更显著（P＜0.05）。治疗后,两组血清CRP、PCT、sICAM-1、IL-17、MMP-9水平均较治疗前显著下降（P＜0.05）;且均以治疗组降低更显著（P＜0.05）。结论 喜炎平注射液联合比阿培南治疗重症肺炎的总体疗效满意,能迅速缓解患者症状及体征,减轻肺部感染及全身炎症反应,改善组织器官损伤,促进病情恢复,且安全性较好。     

1例ECMO联合俯卧位通气治疗HIV阳性重症肺炎病人的护理

我国获得性免疫缺陷综合征(AIDS)防治压力大,形势严峻。AIDS疫情报告情况显示,截至2018年9月30日,全国报告现存活人类免疫缺陷病毒(HIV)感染者/AIDS病人849602例,报告死亡262442例。现存活HIV感染者497231例,AIDS病人352371例[1]。感染HIV后机体免疫细胞严重受损,导致机体抵抗疾病的能力逐渐下降,直至完全失去,而发生多种难以治愈的感染和肿瘤,最终导致死亡[2]。     

雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿

目的：观察雷珠单抗联合577nm微脉冲激光治疗重度糖尿病性黄斑水肿(DME)的临床疗效。

方法：选取2016-06/2019-09就诊于广西壮族自治区人民医院确诊为重度DME的患者52例52眼,随机分为观察组(26例26眼,予雷珠单抗联合577nm微脉冲激光治疗)和对照组(26例26眼,仅予雷珠单抗治疗)。两组患者均予“3+PRN”方案行玻璃体腔注射雷珠单抗治疗。治疗(首次玻璃体腔注射)后随访9mo,观察黄斑中心凹厚度(CMT)、最佳矫正视力(BCVA)情况及玻璃体腔注射雷珠单抗次数。

结果：与治疗前相比,两组患者治疗后各时间点CMT、BCVA均明显改善(均P<0.001),但两组间均无差异(P>0.05)。随访期间,观察组玻璃体腔雷珠单抗注射次数明显少于对照组(5.88±1.24次 vs 7.12±1.24次,P=0.001)。

结论：雷珠单抗联合577nm微脉冲激光和单用雷珠单抗均能有效降低重度DME患者黄斑水肿程度,改善视力,但联合治疗可减少雷珠单抗的注射次数。