Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions r...Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.展开更多
BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disordercaused by circulating autoantibodies against factor Ⅷ (FⅧ). In approximately50% of the patients, the condition is associated w...BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disordercaused by circulating autoantibodies against factor Ⅷ (FⅧ). In approximately50% of the patients, the condition is associated with autoimmune diseases,cancers, medication use, pregnancy, and the post-partum period. Bullous pemphigoid(BP) is a chronic autoimmune subepidermal blistering disease associatedwith tissue-bound and circulating autoantibodies against BP antigens 180 (BP180)and 230 (BP230). AHA-associated BP has a high mortality rate;hence, the understandingof this disease must improve.CASE SUMMARY A 69-year-old man presented with erythema, blisters, blood blisters, and crustsaccompanied by severe pruritus for more than 20 days, and ecchymosis andswelling on his left upper arm for 3 days. Pathological examination revealed asubepidermal blister that contained eosinophils. Laboratory tests showed that theBP180 autoantibody levels had increased, isolated activated partial thromboplastintime was notably prolonged (115.6 s), and coagulation FⅧ activity wasextremely low (< 1.0%). Furthermore, the FⅧ inhibitor titer had greatlyincreased (59.2 Bethesda units). Therefore, the patient was diagnosed as having BP associated with AHA, prescribed 0.05% topical halometasone cream, and transferred to a higher-level hospitalfor effective treatment;however, he died after 2 days.CONCLUSION AHA associated BP is rare, dangerous, and has a high mortality rate. Therefore, its timely diagnosis and effectivetreatment are necessary.展开更多
OBJECTIVE:To comprehensively evaluate randomized controlled trials(RCTs)investigating the effects of moxibustion on people with human immunodeficiency virus(HIV)disease.METHODS:A systematic search was conducted across...OBJECTIVE:To comprehensively evaluate randomized controlled trials(RCTs)investigating the effects of moxibustion on people with human immunodeficiency virus(HIV)disease.METHODS:A systematic search was conducted across eight electronic databases up to August 20,2024.The primary outcome were all-cause mortality and acquired immunodeficiency syndrome(AIDS)-related mortality.Two authors independently screened titles and abstracts,and extracted data onto a pre-designed datasheet.Discrepancies were resolved through consensus.The Cochrane risk-of-bias tool 2.0 was used to assess methodological quality,Meta-analysis was performed when appropriate,and the quality of evidence was assessed through Grading of Recommendations,Assessment,Development and Evaluations approach.RESULTS:Eleven RCTs(n=834)on moxibustion for HIV/AIDS were included,focusing on individuals with HIV infection(5 RCTs,n=426),AIDS patients(3 RCTs,n=223),or both(3 RCTs,n=185).Complications identified included diarrhea(5 RCTs),pulmonary infection(1 RCT),anxiety and depression(1 RCT)and peripheral neuropathy(1 RCT).The risk of bias in the included RCTs was assessed as either high or uncertain.No trial reported mortality or the incidence of AIDS-related complications following treatment.Wheat-grain sized cone moxibustion was associated with increased CD4+counts in patients with lung infections[1 RCT,n=36,mean difference(MD)=78.83 cells/μL].Individual studies reported improvements of quality of life,as measured by the World Health Organization Quality of Life-Brief Version(WHOQOL-BREF)and WHOQOL HIV instrument,with various moxibustion types,but clinical heterogeneity prevented data pooling.Additionally,some studies reported symptom improvement,each using different criteria for symptom improvement.Moxa stick moxibustion plus Western Medicine compared with Western Medicine alone showed a non-significant trend towards improved symptom resolution[2 RCTs,n=125,risk ratio=1.19,95%confidence interval(0.99,1.43)].Moxibustion plus antiretroviral therapy(ART)may reduce gastrointestinal adverse events compared to ART alone[1 RCT,n=10014%vs 32%,P<0.05].The quality of evidence was low to very low.CONCLUSION:This systematic review suggests that moxibustion as an adjunct therapy may have potential benefits in improving immune function and quality of life for HIV/AIDS patients.Limited quality of evidence precludes definitive conclusions,and further high-quality research is needed.展开更多
Acquired hemophilia A(AHA)is a rare blood disorder that can cause life-threatening severe bleeding because of the development of autoantibodies(inhibitors)against factor VIII.AHA is common in elderly patients,and alth...Acquired hemophilia A(AHA)is a rare blood disorder that can cause life-threatening severe bleeding because of the development of autoantibodies(inhibitors)against factor VIII.AHA is common in elderly patients,and although most cases are characterized by subcutaneous or intramuscular bleeding,rare cases of gastrointestinal bleeding have been reported.Controlling gastrointestinal bleeding in patients with AHA is difficult even after multiple endoscopic hemostasis or transcatheter arterial embolization procedures,and these patients are prone to rebleeding.CASE SUMMARY We report the case of a 76-year-old Japanese woman with AHA who presented with repeated bleeding from an esophageal ulcer as the initial symptom.A hemorrhagic ulcer was detected in the lower esophagus,and endoscopic hemostasis using radiofrequency ablation was performed seven times over a month.However,this procedure was unsuccessful,and the patient was transferred to our department.Hypertonic saline-epinephrine injection plus clipping was administered for endoscopic hemostasis,but the treatment response of the patient was poor.After the AHA diagnosis was confirmed,a single dose of a mixture of factors VIIa and X was administered as a bypass hemostatic agent,and the bleeding was successfully controlled.In addition,emicizumab,a bispecific monoclonal antibody that is a substitute for activated factor VIII,was administered,and no further rebleeding was observed.CONCLUSION Multidisciplinary interventions between endoscopists and hematologists are essential to manage rare gastrointestinal bleeding caused by coagulation disorders,such as AHA.展开更多
BACKGROUND Acquired hemophilia A(AHA)is a rare autoimmune bleeding disorder charac-terized by autoantibodies against coagulation factor VIII(FVIII),leading to spon-taneous bleeding in patients without a personal or fa...BACKGROUND Acquired hemophilia A(AHA)is a rare autoimmune bleeding disorder charac-terized by autoantibodies against coagulation factor VIII(FVIII),leading to spon-taneous bleeding in patients without a personal or family history of bleeding disorders.While AHA has been reported in association with various cancers,this case represents,to our knowledge,the first reported instance of AHA following head and neck cancer surgery and subsequent chemoradiotherapy.CASE SUMMARY We present the case of a 65-year-old male with a history of hypopharyngeal squa-mous cell carcinoma(T4bN2cM0,AJCC 8^(th) edition)who developed AHA after extensive surgical resection and chemoradiotherapy.He presented with recurrent hemoptysis and ecchymosis.Coagulation studies showed isolated prolonged activated partial thromboplastin time of 83.8 seconds that did not correct with mixing studies.FVIII activity was<1%,and a Bethesda assay confirmed FVIII inhibitors with a titer of 18.4 Bethesda units.Hemostasis was initially achieved with tranexamic acid and batroxobin.Immunosuppression with prednisone and cyclophosphamide was started;due to gastrointestinal bleeding,rituximab was added.Treatment was later transitioned to azathioprine with prednisone,fol-lowed by tapering.FVIII activity recovered to 188.2%,and the patient remained in remission over six years without AHA or malignancy recurrence.CONCLUSION This case underscores vigilance for AHA after head and neck cancer therapy to enable prompt treatment.展开更多
Acquired brain injury(ABI)is an injury that affects the brain structure and function.Traditional ABI treatment strategies,including medications and rehabilitation therapy,exhibit their ability to improve its impairmen...Acquired brain injury(ABI)is an injury that affects the brain structure and function.Traditional ABI treatment strategies,including medications and rehabilitation therapy,exhibit their ability to improve its impairments in cognition,emotion,and physical activity.Recently,near-infrared(NIR)photobiomodulation(PBM)has emerged as a promising physical intervention method for ABI,demonstrating that low-level light therapy can modulate cellular metabolic processes,reduce the in flammation and reactive oxygen species of ABI microenvironments,and promote neural repair and regeneration.Preclinical studies using ABI models have been carried out,revealing the potential of PBM in promoting brain injury recovery although its clinical application is still in its early stages.In this review,we first inspected the possible physical and biological mechanisms of NIR-PBM,and then reported the pathophysiology and physiology of ABI underlying NIR-PBM intervention.Therefore,the potential of NIR-PBM as a therapeutic intervention in ABI was demonstrated and it is also expected that further work can facilitate its clinical applications.展开更多
AIM:To investigate the clinical profile of patients with acquired lacrimal sac mucocele(ALSM)and evaluate the efficacy of endoscopic dacryocystorhinostomy(En-DCR)for this condition.METHODS:En-DCRs were performed on 14...AIM:To investigate the clinical profile of patients with acquired lacrimal sac mucocele(ALSM)and evaluate the efficacy of endoscopic dacryocystorhinostomy(En-DCR)for this condition.METHODS:En-DCRs were performed on 141 patients with ALSM patients from January 2016 to March 2022.The clinical baseline information and magnetic resonance imaging(MRI)images were recorded and summarized.To assess the effectiveness of En-DCR therapy,both anatomical and functional success rate was assessed during a 12mo follow-up.RESULTS:A total of 141 patients,with a mean age of 57.70±14.11y,were enrolled in this study.Majority of the patients were female(n=91;64.54%)and all had unilateral disease.All patients had a previous history of epiphora and purulent secretion,and the duration from lacrimal duct obstruction to mucocele formation ranged from 6 to 120mo.MRI findings consistently revealed an enlarged sac diameter,fluid accumulation separated by a thin rim from adjacent tissues,which is indicative of lacrimal sac mucocele.En-DCR was performed with an anatomical success rate of 93.62%and a functional success rate of 81.56%.CONCLUSION:ALSM is more commonly seen in females and unilaterally.It is essentially a complication of lacrimal duct obstruction.MRI characteristics can be used for precise clinical diagnosis,while En-DCR emerges as an optimal therapy for this condition.Our results provide a comprehensive reference for the diagnosis and treatment of ALSM.展开更多
AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at Fir...AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People’s Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study.Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality.Further stratification was performed according to preoperative deviation angles[>35 prism diopters(PD)vs≤35 PD]and age(≥18 years adult group vs<18 years adolescent group).The baseline patient characteristics were collected,deviation angles at multiple timepoints before and after treatment were measured,and stereopsis test results were documented.Through comparative analysis of therapeutic outcomes across subgroups,we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included.At the final follow-up,both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001).Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05).For patients with deviations>35 PD,surgery yielded significantly better outcomes than injection therapy in postoperative angle,success rate,and stereopsis recovery(P<0.05).Similarly,in patients aged≥18 years,surgical treatment was superior to injections in reducing strabismus angle,improving success rates,and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE.Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy,particularly in patients with deviations>35 PD and those aged≥18 years.For patients with angles≤35 PD or under 18 years,BTXA injection remains a viable treatment option.展开更多
Type III acute acquired comitant esotropia(AACE)is a special type of binocular coordination disorder with sudden onset characteristics,but its pathogenesis and treatment strategies remain unclear.This article analyzes...Type III acute acquired comitant esotropia(AACE)is a special type of binocular coordination disorder with sudden onset characteristics,but its pathogenesis and treatment strategies remain unclear.This article analyzes the incidence and classification characteristics of Type III AACE,and explores its pathogenesis from multiple perspectives including clinical medicine,neuroscience,and neuro-ophthalmology.It is found that this disease is associated with factors such as decompensation of phoria,dysfunction of the visual center,abnormalities in the physiological and anatomical structure of extraocular muscles,accommodative factors,and disorders of convergence and divergence.The prognosis of Type III AACE is excellent with treatments such as botulinum toxin injection and surgery,and adjunctive therapies like prism adaptation test and visual function training can enhance the management effect.This article provides an in-depth analysis of the pathogenesis and cutting-edge treatment techniques for patients with Type III AACE,which can offer guidance for the subsequent diagnosis and treatment of such patients.展开更多
BACKGROUND Mycoplasma pneumoniae(M.pneumoniae)is considered to be one of the causative agents of community acquired pneumonia in children with general or severe course of disease.Severe M.pneumoniae pneumonia(SMPP)has...BACKGROUND Mycoplasma pneumoniae(M.pneumoniae)is considered to be one of the causative agents of community acquired pneumonia in children with general or severe course of disease.Severe M.pneumoniae pneumonia(SMPP)has emerged as a crucial global health concern due to high mortality rate in children under 5 years,potentially life-threatening complications,and growing challenges in pediatric treatment associated with rising macrolide resistance.Additionally,MPP can be complicated by other bacterial and/or viral pathogens,which may exacerbate disease severity.After the lifting of strict non-pharmaceutical interventions(NPIs)worldwide,the dramatic rise of incidence of MPP in Asia and Europe was observed.AIM To perform the comprehensive study of community acquired MPP cases registered in 2023 in Baoding Hospital,China.METHODS A total of 1160 children from 1 month to 15 years old with confirmed MPP diagnosis were enrolled in the study.The blood and respiratory samples were collected within the 24 hours after admission.The hematological parameters,biochemical markers,cytokine profiles were assessed.The respiratory samples were tested for the presence of M.pneumoniae and other 23 bacterial/viral pathogens by multiplex polymerase chain reaction(PCR).The macrolide resistance mutations(A2063G,A2064G in the 23S rRNA gene of M.pneumoniae)were determined by PCR.RESULTS Number of MPP cases has dramatically increased starting August with peak in November.SMPP and general MPP(GMPP)were identified in 264 and 896 of 1160 hospitalized children.The binary logistic regression analysis identified six[C-reactive protein(CRP),lactate dehydrogenase,procalcitonin,erythrocyte sedimentation rate,fibrin and fibrinogen degradation products(FDPs),D-dimer]and four(neutrophils,CRP,FDPs,prothrombin time)predictors of SMPP in age groups 2-5 years and 6-15 years,respectively.Children with SMPP showed significantly higher levels of cytokine interleukin(IL)-17F(2-5 years),and cytokines interferon-gamma,tumor necrosis factoralpha,IL-10(6-13 years).Concomitant viral/bacterial pathogens were determined in 24.3%and 28.0%cases of SMPP and GMPP.Among them,Streptococcus pneumoniae(S.pneumoniae)and Haemophilus influenzae(H.influenzae)were predominant.93.2%cases of MPP were associated with macrolide resistant M.pneumoniae.CONCLUSION Specific MPP epidemiological pattern associated with lifting NPIs was revealed:Increase of hospitalized cases,prevalence of S.pneumoniae and H.influenzae among concomitant pathogens,93.2%of macrolide resistant M.pneumonia.展开更多
Objective Acquired aplastic anemia(aAA)is characterized by an autologous immunological attack against hematopoietic stem and progenitor cells,and immunotolerance disruption is frequent,with reduced T regulatory cells(...Objective Acquired aplastic anemia(aAA)is characterized by an autologous immunological attack against hematopoietic stem and progenitor cells,and immunotolerance disruption is frequent,with reduced T regulatory cells(Tregs)frequencies and increased effector cytotoxic cells.Tregs are reduced in aAA and increase in number after successful immunosuppressive therapies.Methods In this retrospective study,we investigated the frequency of circulating Tregs by multiparametric flow cytometry immunophenotyping in non-severe aAA patients before and after immunosuppressive therapy.The samples were stained with the following antibodies:ECD anti-CD3,PE or PC5 anti-CD4,FITC anti-CD8,and PE anti-CD25,and Tregs were identified by first gating on linear parameters for lymphocyte identification and then for CD3 expression.In CD3+CD4+cells,Tregs were further identified on the basis of CD25 and FOXP3 expression.Results Although the number of Tregs tended to increase after immunosuppressive treatments,their circulating frequency remained lower than that of healthy subjects,regardless of their responsiveness to therapies.Moreover,the relative frequency combined with absolute Treg counts might be more informative in the differential diagnosis of bone marrow failure syndromes.Conclusions The persistent decrease in circulating Tregs could be the result of immunosuppressive agents that could preferentially expand other T-cell subsets.At the same time,an imbalance in immunotolerance might persist,which is also favored by chronic antigen stimulation.展开更多
OBJECTIVE： To retrospectively study the preva- lence of fatigue and factors associated with fatigue among acquired immunodeficiency syndrome （AIDS） patients with antiretroviral drug adverse re- actions. METHODS： D...OBJECTIVE： To retrospectively study the preva- lence of fatigue and factors associated with fatigue among acquired immunodeficiency syndrome （AIDS） patients with antiretroviral drug adverse re- actions. METHODS： Data were collected from case reportforms （CRFs） for a project funded by the 1 lth Na- tional 5-year Special Science and Technology Pro- gram on Major Infectious Diseases. Fatigue was de- fined by patient self-report. The outcomes were the prevalence of fatigue and the potential risk factors of fatigue. Univariate and multivariate logistic re- gression analyses were conducted to identify the factors associated with fatigue. RESULTS： Among the 228 subjects, the prevalence of fatigue was 86.8%. In univariate analysis, the sig- nificant differences in demographic characteristics between patients with and without fatigue were： gender [OR=2.29; 95% CI （1.05-4.98）], education lev- el [OR=0.40; 95% CI （0.18-0.85）], anemia [OR=3.80; 95% CI （1.27-11.31）], time of HIV diagnosis [OR= 0.29; 95% CI （0.13-0.65）], and route of infection [OR= 0.14; 9.5% CI （0.06-0.32）]. Abnormal taste and rapid pulse were more commonly seen in patients with fatigue （P〈0.05）, while abdominal distension and lumbar soreness were encountered less often in pa- tients with fatigue （P〈0.05）. Multivariate analysis showed that the four main factors associated with fatigue were anemia [OR=3.S0; 95% CI （1.01 -12.15）], route of infection [OR=3.40; 95% CI （1.21-9.58）; P= 0.02〈0.05], lumbar soreness [OR=0.06; 95% CI （0.02-0.18）; P=0.000〈0.05], and rapid pulse [OR= 10.58; 95% C/（2.16-51.75）; P=0.004〈0.05]. CONCLUSION： This study demonstrated that fa- tigue is common （86.8% prevalence） in AIDS pa- tients with antiretroviral drug adverse reactions, and that anemia, route of infection （i.e., non-com- mercial blood donation） and rapid pulse were risk factors, while lumbar soreness was a protective fac- tor related to fatigue. More attention should bepaid to fatigue and more efforts should be made to find ways to prevent, control and eliminate this symptom in AIDS patients with antiretroviral drug adverse reactions.展开更多
OBJECTIVE:To investigate the effect of a treatment course of comprehensive intervention with Traditional Chinese Medicine(TCM) on the mortality of patients with acquired immunodeficiency syndrome(AIDS) treated with co...OBJECTIVE:To investigate the effect of a treatment course of comprehensive intervention with Traditional Chinese Medicine(TCM) on the mortality of patients with acquired immunodeficiency syndrome(AIDS) treated with combined antiretroviral therapy(c ART).METHODS:AIDS patients who had taken c ART in a national TCM human immunodeficiency virus treatment trial program(NTCMTP) before 2009 were enrolled in this study and followed for 36 months from November 2009.Patients enrolled in the NTCMTP in 2004 were taken as the first group,those enrolled in 2006 as the second group,and those enrolled in 2009 as the third group.Cumulative survival rates were calculated by the life table method.Survival curves for subgroups were compared by the log-rank test.Hazard ratios were calculated with a Cox proportional hazards model.RESULTS:A total of 1443 AIDS patients were followed for 3 years(4198 person-years).During this period,91(6.3%) patients died and 13(0.9%) were lost to follow-up.The total mortality rate was 2.17/100 person-years.The mortality rate of patients enrolled in the NTCMTP in 2004 was 1.49/100 person-years,which was lower than that of patients enrolled in 2006(2.23/100 person-years) and 2009(3.48/100 person-years).After adjusting for other factors,a shorter time of treatment with TCM,male sex,older age,lower CD4 + T-cell counts,and long-term treatment with c ART were risk factors of mortality.CONCLUSION:Long-term treatment with TCM decreased the mortality risk of AIDS patients.Factors such as being male,older age,CD4+ T-cell counts,and time of treatment with TCM and c ART were correlated with mortality.展开更多
AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatenin...AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.METHODS: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2)exclusion of congenital diverticula (e.g. Meckel's diverticulum).RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6±3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel series.CONCLUSION: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease.展开更多
Complementary and alternative medicine, including Chinese medicine(CM), has been used to treat acquired immune deficiency syndrome(AIDS) for almost 30 years. We aimed to compare the main differences between AIDS treat...Complementary and alternative medicine, including Chinese medicine(CM), has been used to treat acquired immune deficiency syndrome(AIDS) for almost 30 years. We aimed to compare the main differences between AIDS treatment and evaluation strategies between CM and Western Medicine(WM), and analyze advantages and disadvantages.The characteristics of integrative medicine(IM),based on CM and WM, include a patient-centered mode of medicine based on evidence. IM focuses on complex intervention and management with systemic and individual treatment. The evaluation indexes of IM might consist of objective indicators and subjective indexes. IM might be a more valuable method for treating AIDS in the future instead of WM or CM alone.展开更多
Major advances have been made over the past few decades in identifying and managing disorders of consciousness(DOC)in patients with acquired brain injury(ABI),bringing the transformation from a conceptualized definiti...Major advances have been made over the past few decades in identifying and managing disorders of consciousness(DOC)in patients with acquired brain injury(ABI),bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration.Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools,sophisticated neuroimaging,and electrophysiological techniques,a considerably higher diagnostic accuracy rate of DOC may now be reached.During the treatment of patients with DOC,a variety of intervention methods are available,including amantadine and transcranial direct current stimulation,which have both provided class II evidence,zolpidem,which is also of high quality,and non-invasive stimulation,which appears to be more encouraging than pharmacological therapy.However,heterogeneity is profoundly ingrained in study designs,and only rare schemes have been recommended by authoritative institutions.There is still a lack of an effective clinical protocol for managing patients with DOC following ABI.To advance future clinical studies on DOC,we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC.We propose a preliminary clinical decision protocol,which could serve as an ideal reference tool for many medical institutions.展开更多
We report the first case of a patient with hepatitis C virus(HCV) infection and idiopathic thrombocytopenic purpura(ITP), who later developed acquired amegakaryocytic thrombocytopenia(AAMT), with autoantibodies to the...We report the first case of a patient with hepatitis C virus(HCV) infection and idiopathic thrombocytopenic purpura(ITP), who later developed acquired amegakaryocytic thrombocytopenia(AAMT), with autoantibodies to the thrombopoietin(TPO) receptor(c-Mpl). A 64-year-old woman, with chronic hepatitis C, developed severe thrombocytopenia and was diagnosed with ITP. She died of liver failure. Autopsy revealed cirrhosis and liver carcinoma. In the bone marrow, a marked reduction in the number of megakaryocytes was observed, while other cell lineages were preserved. Therefore, she was diagnosed with AAMT. Additionally, autoantibodies to c-Mpl were detected in her serum. Autoantibodies to c-Mpl are one of the causes of AAMT, acting through inhibition of TPO function, megakaryocytic maturation, and platelet formation. HCV infection induces several autoantibodies. HCV infection might also induce autoantibodies to c-Mpl, resulting in the development of AAMT. This mechanism may be one of the causes of thrombocytopenia in patients with HCV infection.展开更多
OBJECTIVE:To systematically review the efficacy and safety ofTraditional Chinese Medicine(TCM)interventions,compared with control interventions(placebo or conventional Western medical therapy),in the treatment of acqu...OBJECTIVE:To systematically review the efficacy and safety ofTraditional Chinese Medicine(TCM)interventions,compared with control interventions(placebo or conventional Western medical therapy),in the treatment of acquired immunodeficiency syndrome(AIDS).METHODS:Electronic databases including PubMed,the Cochrane Library,China National Knowledge Infrastructure(CNKI),and Wanfang Data were searched to identify relevant randomized controlled trials(RCTs)published as of May 2012.Studies were selected according to the specified inclusion and exclusion criteria and then subjected to methodological quality assessment,data extraction,and meta-analysis according to the Cochrane Handbook for Systematic Reviews of Interventions.RESULTS:Twelve RCTs involving 881 patients with AIDS were included.Methodological quality assessment showed that two were high-quality,two were moderate-quality,and eight were low-quality.Meta-analysis showed that TCM interventions were associated with significantly reduced plasma viral load compared with placebo[odds ratio OR=2.46,95%confidence interval CI(1.02,5.94);P=0.04].However,the reductions in plasma viral load significantly favored conventional Western medical therapy alone over integrated traditional Chinese and Western medical therapy[OR=0.16,95%CI(0.05,0.55);P=0.004].Patients receiving TCM interventions had significantly higher CD4+T lymphocyte counts compared with those on placebo[OR=2.54,95%CI(1.40,4.60);P=0.002].In addition,TCM interventions were significantly more likely to have improved clinical symptoms[OR=2.82,95%CI(1.85,4.31);P<0.00001].TCM interventions conferred a similar risk of adverse events(AEs)compared with control interventions[OR=1.87,95%CI(0.58,6.01);P=0.29].CONCLUSION:Current evidence suggests that TCM interventions are significantly more effective than placebo in reducing plasma viral load and increasing CD4+T lymphocyte count in patients with AIDS.When compared with conventional Western medical therapy,TCM interventions were significantly less effective in reducing plasma viral load,although they were associated with a higher percentage of patients with improved symptoms.Patients receiving TCM interventions did not seem to be at an increased risk of AEs.展开更多
AIM：To compare the clinical manifestation of cytomegalovirus（CMV）retinitis and microvascular retinopathy（MVR）in patients with acquired immunodeficiency syndrome（AIDS）in China.METHODS：A total of 93 consecutive ...AIM：To compare the clinical manifestation of cytomegalovirus（CMV）retinitis and microvascular retinopathy（MVR）in patients with acquired immunodeficiency syndrome（AIDS）in China.METHODS：A total of 93 consecutive patients with AIDS,including 41 cases of CMV retinitis and 52 cases of MVR were retrospectively reviewed.Highly active antiretroviral therapy（HAART）status was recorded.HIV and CMV immunoassay were also tested.CD4＋T-lymphocyte count and blood CMV-DNA test were performed in all patients.Aqueous humor CMV-DNA test was completed in 39patients.Ophthalmological examinations including best corrected visual acuity（BCVA,by International Standard Vision Chart）,intraocular pressure（IOP）,slit-lamp biomicroscopy,indirect ophthalmoscopy were performed.RESULTS：In MVR group,the anterior segment examination was normal in all patients with a mean BCVA of 0.93±0.13.Blood CMV-DNA was 0（0,269 000）and 42 patients（80.77%）did not receive HAART.In CMV retinitis group,13 patients（31.71%）had anterior segment abnormality.The mean BCVA was 0.64±0.35 and blood CMV-DNA was 3470（0,1 450 000）.Nineteen patients（46.34%）had not received HAART.MVR group and CMV retinitis group the positive rates of aqueous CMV-DNA were 0 and 50%,respectively.Two patients with MVR progressed to CMV retinitis during the follow-up period.CONCLUSION：In comparison of CMV,patients with MVR have relatively mild visual function impairment.Careful ophthalmological examination and close follow-up are mandatory,especially for patients who have systemic complications,positive CMV-DNA test and without received HAART.展开更多
文摘Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.
基金Supported by Traditional Chinese Medicine Research Program of Hebei Provincial Administration of Traditional Chinese Medicine,No.2025313 and No.2025448.
文摘BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disordercaused by circulating autoantibodies against factor Ⅷ (FⅧ). In approximately50% of the patients, the condition is associated with autoimmune diseases,cancers, medication use, pregnancy, and the post-partum period. Bullous pemphigoid(BP) is a chronic autoimmune subepidermal blistering disease associatedwith tissue-bound and circulating autoantibodies against BP antigens 180 (BP180)and 230 (BP230). AHA-associated BP has a high mortality rate;hence, the understandingof this disease must improve.CASE SUMMARY A 69-year-old man presented with erythema, blisters, blood blisters, and crustsaccompanied by severe pruritus for more than 20 days, and ecchymosis andswelling on his left upper arm for 3 days. Pathological examination revealed asubepidermal blister that contained eosinophils. Laboratory tests showed that theBP180 autoantibody levels had increased, isolated activated partial thromboplastintime was notably prolonged (115.6 s), and coagulation FⅧ activity wasextremely low (< 1.0%). Furthermore, the FⅧ inhibitor titer had greatlyincreased (59.2 Bethesda units). Therefore, the patient was diagnosed as having BP associated with AHA, prescribed 0.05% topical halometasone cream, and transferred to a higher-level hospitalfor effective treatment;however, he died after 2 days.CONCLUSION AHA associated BP is rare, dangerous, and has a high mortality rate. Therefore, its timely diagnosis and effectivetreatment are necessary.
基金High-level Traditional Chinese Medicine key subjects construction project of National Administration of Traditional Chinese Medicine-Evidence-based Traditional Chinese Medicine(zyyzdxk-2023249)vip Professor of Beijing University of Chinese Medicine(20210017)。
文摘OBJECTIVE:To comprehensively evaluate randomized controlled trials(RCTs)investigating the effects of moxibustion on people with human immunodeficiency virus(HIV)disease.METHODS:A systematic search was conducted across eight electronic databases up to August 20,2024.The primary outcome were all-cause mortality and acquired immunodeficiency syndrome(AIDS)-related mortality.Two authors independently screened titles and abstracts,and extracted data onto a pre-designed datasheet.Discrepancies were resolved through consensus.The Cochrane risk-of-bias tool 2.0 was used to assess methodological quality,Meta-analysis was performed when appropriate,and the quality of evidence was assessed through Grading of Recommendations,Assessment,Development and Evaluations approach.RESULTS:Eleven RCTs(n=834)on moxibustion for HIV/AIDS were included,focusing on individuals with HIV infection(5 RCTs,n=426),AIDS patients(3 RCTs,n=223),or both(3 RCTs,n=185).Complications identified included diarrhea(5 RCTs),pulmonary infection(1 RCT),anxiety and depression(1 RCT)and peripheral neuropathy(1 RCT).The risk of bias in the included RCTs was assessed as either high or uncertain.No trial reported mortality or the incidence of AIDS-related complications following treatment.Wheat-grain sized cone moxibustion was associated with increased CD4+counts in patients with lung infections[1 RCT,n=36,mean difference(MD)=78.83 cells/μL].Individual studies reported improvements of quality of life,as measured by the World Health Organization Quality of Life-Brief Version(WHOQOL-BREF)and WHOQOL HIV instrument,with various moxibustion types,but clinical heterogeneity prevented data pooling.Additionally,some studies reported symptom improvement,each using different criteria for symptom improvement.Moxa stick moxibustion plus Western Medicine compared with Western Medicine alone showed a non-significant trend towards improved symptom resolution[2 RCTs,n=125,risk ratio=1.19,95%confidence interval(0.99,1.43)].Moxibustion plus antiretroviral therapy(ART)may reduce gastrointestinal adverse events compared to ART alone[1 RCT,n=10014%vs 32%,P<0.05].The quality of evidence was low to very low.CONCLUSION:This systematic review suggests that moxibustion as an adjunct therapy may have potential benefits in improving immune function and quality of life for HIV/AIDS patients.Limited quality of evidence precludes definitive conclusions,and further high-quality research is needed.
文摘Acquired hemophilia A(AHA)is a rare blood disorder that can cause life-threatening severe bleeding because of the development of autoantibodies(inhibitors)against factor VIII.AHA is common in elderly patients,and although most cases are characterized by subcutaneous or intramuscular bleeding,rare cases of gastrointestinal bleeding have been reported.Controlling gastrointestinal bleeding in patients with AHA is difficult even after multiple endoscopic hemostasis or transcatheter arterial embolization procedures,and these patients are prone to rebleeding.CASE SUMMARY We report the case of a 76-year-old Japanese woman with AHA who presented with repeated bleeding from an esophageal ulcer as the initial symptom.A hemorrhagic ulcer was detected in the lower esophagus,and endoscopic hemostasis using radiofrequency ablation was performed seven times over a month.However,this procedure was unsuccessful,and the patient was transferred to our department.Hypertonic saline-epinephrine injection plus clipping was administered for endoscopic hemostasis,but the treatment response of the patient was poor.After the AHA diagnosis was confirmed,a single dose of a mixture of factors VIIa and X was administered as a bypass hemostatic agent,and the bleeding was successfully controlled.In addition,emicizumab,a bispecific monoclonal antibody that is a substitute for activated factor VIII,was administered,and no further rebleeding was observed.CONCLUSION Multidisciplinary interventions between endoscopists and hematologists are essential to manage rare gastrointestinal bleeding caused by coagulation disorders,such as AHA.
文摘BACKGROUND Acquired hemophilia A(AHA)is a rare autoimmune bleeding disorder charac-terized by autoantibodies against coagulation factor VIII(FVIII),leading to spon-taneous bleeding in patients without a personal or family history of bleeding disorders.While AHA has been reported in association with various cancers,this case represents,to our knowledge,the first reported instance of AHA following head and neck cancer surgery and subsequent chemoradiotherapy.CASE SUMMARY We present the case of a 65-year-old male with a history of hypopharyngeal squa-mous cell carcinoma(T4bN2cM0,AJCC 8^(th) edition)who developed AHA after extensive surgical resection and chemoradiotherapy.He presented with recurrent hemoptysis and ecchymosis.Coagulation studies showed isolated prolonged activated partial thromboplastin time of 83.8 seconds that did not correct with mixing studies.FVIII activity was<1%,and a Bethesda assay confirmed FVIII inhibitors with a titer of 18.4 Bethesda units.Hemostasis was initially achieved with tranexamic acid and batroxobin.Immunosuppression with prednisone and cyclophosphamide was started;due to gastrointestinal bleeding,rituximab was added.Treatment was later transitioned to azathioprine with prednisone,fol-lowed by tapering.FVIII activity recovered to 188.2%,and the patient remained in remission over six years without AHA or malignancy recurrence.CONCLUSION This case underscores vigilance for AHA after head and neck cancer therapy to enable prompt treatment.
基金supported by the University of Macao(MYRG2022-00054-FHS and MYRGGRG2023-00038-FHS-UMDF)the Macao Science and Technology Development Fund(FDCT0048/2021/AGJ and FDCT0020/2019/AMJ)Natural Science Foundation of Guangdong Province(EF017/FHS-YZ/2021/GDSTC).
文摘Acquired brain injury(ABI)is an injury that affects the brain structure and function.Traditional ABI treatment strategies,including medications and rehabilitation therapy,exhibit their ability to improve its impairments in cognition,emotion,and physical activity.Recently,near-infrared(NIR)photobiomodulation(PBM)has emerged as a promising physical intervention method for ABI,demonstrating that low-level light therapy can modulate cellular metabolic processes,reduce the in flammation and reactive oxygen species of ABI microenvironments,and promote neural repair and regeneration.Preclinical studies using ABI models have been carried out,revealing the potential of PBM in promoting brain injury recovery although its clinical application is still in its early stages.In this review,we first inspected the possible physical and biological mechanisms of NIR-PBM,and then reported the pathophysiology and physiology of ABI underlying NIR-PBM intervention.Therefore,the potential of NIR-PBM as a therapeutic intervention in ABI was demonstrated and it is also expected that further work can facilitate its clinical applications.
文摘AIM:To investigate the clinical profile of patients with acquired lacrimal sac mucocele(ALSM)and evaluate the efficacy of endoscopic dacryocystorhinostomy(En-DCR)for this condition.METHODS:En-DCRs were performed on 141 patients with ALSM patients from January 2016 to March 2022.The clinical baseline information and magnetic resonance imaging(MRI)images were recorded and summarized.To assess the effectiveness of En-DCR therapy,both anatomical and functional success rate was assessed during a 12mo follow-up.RESULTS:A total of 141 patients,with a mean age of 57.70±14.11y,were enrolled in this study.Majority of the patients were female(n=91;64.54%)and all had unilateral disease.All patients had a previous history of epiphora and purulent secretion,and the duration from lacrimal duct obstruction to mucocele formation ranged from 6 to 120mo.MRI findings consistently revealed an enlarged sac diameter,fluid accumulation separated by a thin rim from adjacent tissues,which is indicative of lacrimal sac mucocele.En-DCR was performed with an anatomical success rate of 93.62%and a functional success rate of 81.56%.CONCLUSION:ALSM is more commonly seen in females and unilaterally.It is essentially a complication of lacrimal duct obstruction.MRI characteristics can be used for precise clinical diagnosis,while En-DCR emerges as an optimal therapy for this condition.Our results provide a comprehensive reference for the diagnosis and treatment of ALSM.
文摘AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People’s Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study.Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality.Further stratification was performed according to preoperative deviation angles[>35 prism diopters(PD)vs≤35 PD]and age(≥18 years adult group vs<18 years adolescent group).The baseline patient characteristics were collected,deviation angles at multiple timepoints before and after treatment were measured,and stereopsis test results were documented.Through comparative analysis of therapeutic outcomes across subgroups,we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included.At the final follow-up,both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001).Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05).For patients with deviations>35 PD,surgery yielded significantly better outcomes than injection therapy in postoperative angle,success rate,and stereopsis recovery(P<0.05).Similarly,in patients aged≥18 years,surgical treatment was superior to injections in reducing strabismus angle,improving success rates,and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE.Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy,particularly in patients with deviations>35 PD and those aged≥18 years.For patients with angles≤35 PD or under 18 years,BTXA injection remains a viable treatment option.
文摘Type III acute acquired comitant esotropia(AACE)is a special type of binocular coordination disorder with sudden onset characteristics,but its pathogenesis and treatment strategies remain unclear.This article analyzes the incidence and classification characteristics of Type III AACE,and explores its pathogenesis from multiple perspectives including clinical medicine,neuroscience,and neuro-ophthalmology.It is found that this disease is associated with factors such as decompensation of phoria,dysfunction of the visual center,abnormalities in the physiological and anatomical structure of extraocular muscles,accommodative factors,and disorders of convergence and divergence.The prognosis of Type III AACE is excellent with treatments such as botulinum toxin injection and surgery,and adjunctive therapies like prism adaptation test and visual function training can enhance the management effect.This article provides an in-depth analysis of the pathogenesis and cutting-edge treatment techniques for patients with Type III AACE,which can offer guidance for the subsequent diagnosis and treatment of such patients.
基金Supported by Baoding Science and Technology Plan Project,No.2272P011Hebei Province Scientific Research Project,No.20241734Hebei Natural Science Foundation Project,No.H2024104011.
文摘BACKGROUND Mycoplasma pneumoniae(M.pneumoniae)is considered to be one of the causative agents of community acquired pneumonia in children with general or severe course of disease.Severe M.pneumoniae pneumonia(SMPP)has emerged as a crucial global health concern due to high mortality rate in children under 5 years,potentially life-threatening complications,and growing challenges in pediatric treatment associated with rising macrolide resistance.Additionally,MPP can be complicated by other bacterial and/or viral pathogens,which may exacerbate disease severity.After the lifting of strict non-pharmaceutical interventions(NPIs)worldwide,the dramatic rise of incidence of MPP in Asia and Europe was observed.AIM To perform the comprehensive study of community acquired MPP cases registered in 2023 in Baoding Hospital,China.METHODS A total of 1160 children from 1 month to 15 years old with confirmed MPP diagnosis were enrolled in the study.The blood and respiratory samples were collected within the 24 hours after admission.The hematological parameters,biochemical markers,cytokine profiles were assessed.The respiratory samples were tested for the presence of M.pneumoniae and other 23 bacterial/viral pathogens by multiplex polymerase chain reaction(PCR).The macrolide resistance mutations(A2063G,A2064G in the 23S rRNA gene of M.pneumoniae)were determined by PCR.RESULTS Number of MPP cases has dramatically increased starting August with peak in November.SMPP and general MPP(GMPP)were identified in 264 and 896 of 1160 hospitalized children.The binary logistic regression analysis identified six[C-reactive protein(CRP),lactate dehydrogenase,procalcitonin,erythrocyte sedimentation rate,fibrin and fibrinogen degradation products(FDPs),D-dimer]and four(neutrophils,CRP,FDPs,prothrombin time)predictors of SMPP in age groups 2-5 years and 6-15 years,respectively.Children with SMPP showed significantly higher levels of cytokine interleukin(IL)-17F(2-5 years),and cytokines interferon-gamma,tumor necrosis factoralpha,IL-10(6-13 years).Concomitant viral/bacterial pathogens were determined in 24.3%and 28.0%cases of SMPP and GMPP.Among them,Streptococcus pneumoniae(S.pneumoniae)and Haemophilus influenzae(H.influenzae)were predominant.93.2%cases of MPP were associated with macrolide resistant M.pneumoniae.CONCLUSION Specific MPP epidemiological pattern associated with lifting NPIs was revealed:Increase of hospitalized cases,prevalence of S.pneumoniae and H.influenzae among concomitant pathogens,93.2%of macrolide resistant M.pneumonia.
文摘Objective Acquired aplastic anemia(aAA)is characterized by an autologous immunological attack against hematopoietic stem and progenitor cells,and immunotolerance disruption is frequent,with reduced T regulatory cells(Tregs)frequencies and increased effector cytotoxic cells.Tregs are reduced in aAA and increase in number after successful immunosuppressive therapies.Methods In this retrospective study,we investigated the frequency of circulating Tregs by multiparametric flow cytometry immunophenotyping in non-severe aAA patients before and after immunosuppressive therapy.The samples were stained with the following antibodies:ECD anti-CD3,PE or PC5 anti-CD4,FITC anti-CD8,and PE anti-CD25,and Tregs were identified by first gating on linear parameters for lymphocyte identification and then for CD3 expression.In CD3+CD4+cells,Tregs were further identified on the basis of CD25 and FOXP3 expression.Results Although the number of Tregs tended to increase after immunosuppressive treatments,their circulating frequency remained lower than that of healthy subjects,regardless of their responsiveness to therapies.Moreover,the relative frequency combined with absolute Treg counts might be more informative in the differential diagnosis of bone marrow failure syndromes.Conclusions The persistent decrease in circulating Tregs could be the result of immunosuppressive agents that could preferentially expand other T-cell subsets.At the same time,an imbalance in immunotolerance might persist,which is also favored by chronic antigen stimulation.
基金Supported by 11th National 5-year Special Science and Technology Program on Major Infectious Diseases(No.2008ZX10005-003,2012ZX10005010-001)Research Projectfor Practice Development of National TCM Clinical Research Bases(No.JDZX2012020)Scientists and Technicians Troop Construction Project of Zhengzhou City(No.10CXTD140)
文摘OBJECTIVE： To retrospectively study the preva- lence of fatigue and factors associated with fatigue among acquired immunodeficiency syndrome （AIDS） patients with antiretroviral drug adverse re- actions. METHODS： Data were collected from case reportforms （CRFs） for a project funded by the 1 lth Na- tional 5-year Special Science and Technology Pro- gram on Major Infectious Diseases. Fatigue was de- fined by patient self-report. The outcomes were the prevalence of fatigue and the potential risk factors of fatigue. Univariate and multivariate logistic re- gression analyses were conducted to identify the factors associated with fatigue. RESULTS： Among the 228 subjects, the prevalence of fatigue was 86.8%. In univariate analysis, the sig- nificant differences in demographic characteristics between patients with and without fatigue were： gender [OR=2.29; 95% CI （1.05-4.98）], education lev- el [OR=0.40; 95% CI （0.18-0.85）], anemia [OR=3.80; 95% CI （1.27-11.31）], time of HIV diagnosis [OR= 0.29; 95% CI （0.13-0.65）], and route of infection [OR= 0.14; 9.5% CI （0.06-0.32）]. Abnormal taste and rapid pulse were more commonly seen in patients with fatigue （P〈0.05）, while abdominal distension and lumbar soreness were encountered less often in pa- tients with fatigue （P〈0.05）. Multivariate analysis showed that the four main factors associated with fatigue were anemia [OR=3.S0; 95% CI （1.01 -12.15）], route of infection [OR=3.40; 95% CI （1.21-9.58）; P= 0.02〈0.05], lumbar soreness [OR=0.06; 95% CI （0.02-0.18）; P=0.000〈0.05], and rapid pulse [OR= 10.58; 95% C/（2.16-51.75）; P=0.004〈0.05]. CONCLUSION： This study demonstrated that fa- tigue is common （86.8% prevalence） in AIDS pa- tients with antiretroviral drug adverse reactions, and that anemia, route of infection （i.e., non-com- mercial blood donation） and rapid pulse were risk factors, while lumbar soreness was a protective fac- tor related to fatigue. More attention should bepaid to fatigue and more efforts should be made to find ways to prevent, control and eliminate this symptom in AIDS patients with antiretroviral drug adverse reactions.
基金Supported by Research Project for Practice Development of National Traditional Chinese Medicine Clinical Research Bases:Evaluation of the clinical effect of Acquired Immune Deficiency Syndrome Acquired Immunodeficiency Syndrome(AIDS)patients treated with Traditional Chinese Medicine in Henan province between 2004 and 2012(No.JDZX2012035)National Special Science and Technology Program on Major Infectious Diseases(No.2013ZX10005010-001)Special of Scientific Research of Traditional Chinese Medicine of Henan Province in China(No.2015ZY02097)
文摘OBJECTIVE:To investigate the effect of a treatment course of comprehensive intervention with Traditional Chinese Medicine(TCM) on the mortality of patients with acquired immunodeficiency syndrome(AIDS) treated with combined antiretroviral therapy(c ART).METHODS:AIDS patients who had taken c ART in a national TCM human immunodeficiency virus treatment trial program(NTCMTP) before 2009 were enrolled in this study and followed for 36 months from November 2009.Patients enrolled in the NTCMTP in 2004 were taken as the first group,those enrolled in 2006 as the second group,and those enrolled in 2009 as the third group.Cumulative survival rates were calculated by the life table method.Survival curves for subgroups were compared by the log-rank test.Hazard ratios were calculated with a Cox proportional hazards model.RESULTS:A total of 1443 AIDS patients were followed for 3 years(4198 person-years).During this period,91(6.3%) patients died and 13(0.9%) were lost to follow-up.The total mortality rate was 2.17/100 person-years.The mortality rate of patients enrolled in the NTCMTP in 2004 was 1.49/100 person-years,which was lower than that of patients enrolled in 2006(2.23/100 person-years) and 2009(3.48/100 person-years).After adjusting for other factors,a shorter time of treatment with TCM,male sex,older age,lower CD4 + T-cell counts,and long-term treatment with c ART were risk factors of mortality.CONCLUSION:Long-term treatment with TCM decreased the mortality risk of AIDS patients.Factors such as being male,older age,CD4+ T-cell counts,and time of treatment with TCM and c ART were correlated with mortality.
文摘AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.METHODS: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2)exclusion of congenital diverticula (e.g. Meckel's diverticulum).RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6±3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel series.CONCLUSION: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease.
基金Supported by the National Special Science&Technology Program on Major Infectious Diseases(No.2012ZX10005010-001No.2013ZX10005001-001)+1 种基金Henan Province Basic and Advanced Technology Research Project(No.152300410165)Henan Province Colleges and Universities Key Youth Teachers Scheme(No.2013GGJS-095)
文摘Complementary and alternative medicine, including Chinese medicine(CM), has been used to treat acquired immune deficiency syndrome(AIDS) for almost 30 years. We aimed to compare the main differences between AIDS treatment and evaluation strategies between CM and Western Medicine(WM), and analyze advantages and disadvantages.The characteristics of integrative medicine(IM),based on CM and WM, include a patient-centered mode of medicine based on evidence. IM focuses on complex intervention and management with systemic and individual treatment. The evaluation indexes of IM might consist of objective indicators and subjective indexes. IM might be a more valuable method for treating AIDS in the future instead of WM or CM alone.
基金supported by the Shanghai Municipal Science and Technology Major Project(2018SHZDZX01)ZJ Lab,Shanghai Center for Brain Science and Brain-Inspired Technology,and National Major Pre-Research Project(pilot project)(IDF151042).
文摘Major advances have been made over the past few decades in identifying and managing disorders of consciousness(DOC)in patients with acquired brain injury(ABI),bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration.Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools,sophisticated neuroimaging,and electrophysiological techniques,a considerably higher diagnostic accuracy rate of DOC may now be reached.During the treatment of patients with DOC,a variety of intervention methods are available,including amantadine and transcranial direct current stimulation,which have both provided class II evidence,zolpidem,which is also of high quality,and non-invasive stimulation,which appears to be more encouraging than pharmacological therapy.However,heterogeneity is profoundly ingrained in study designs,and only rare schemes have been recommended by authoritative institutions.There is still a lack of an effective clinical protocol for managing patients with DOC following ABI.To advance future clinical studies on DOC,we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC.We propose a preliminary clinical decision protocol,which could serve as an ideal reference tool for many medical institutions.
文摘We report the first case of a patient with hepatitis C virus(HCV) infection and idiopathic thrombocytopenic purpura(ITP), who later developed acquired amegakaryocytic thrombocytopenia(AAMT), with autoantibodies to the thrombopoietin(TPO) receptor(c-Mpl). A 64-year-old woman, with chronic hepatitis C, developed severe thrombocytopenia and was diagnosed with ITP. She died of liver failure. Autopsy revealed cirrhosis and liver carcinoma. In the bone marrow, a marked reduction in the number of megakaryocytes was observed, while other cell lineages were preserved. Therefore, she was diagnosed with AAMT. Additionally, autoantibodies to c-Mpl were detected in her serum. Autoantibodies to c-Mpl are one of the causes of AAMT, acting through inhibition of TPO function, megakaryocytic maturation, and platelet formation. HCV infection induces several autoantibodies. HCV infection might also induce autoantibodies to c-Mpl, resulting in the development of AAMT. This mechanism may be one of the causes of thrombocytopenia in patients with HCV infection.
基金Supported by International Cooperation Project,the Ministry of Science and Technology of the People's Republic of China(S2013ZR0063)Guangxi Key Technologies R&D Program(No.1298003-1-1,11107009-1-3)+2 种基金Guangxi Natural Science Foundation(No.0832016Z)China Postdoctoral Science Foundation(Post Doctor of China Central South Uni-versity 2013M531816)Guangxi Administration of Traditional Chinese Medicine(GZKZ-G1105,GZKZ10-054,2012032)
文摘OBJECTIVE:To systematically review the efficacy and safety ofTraditional Chinese Medicine(TCM)interventions,compared with control interventions(placebo or conventional Western medical therapy),in the treatment of acquired immunodeficiency syndrome(AIDS).METHODS:Electronic databases including PubMed,the Cochrane Library,China National Knowledge Infrastructure(CNKI),and Wanfang Data were searched to identify relevant randomized controlled trials(RCTs)published as of May 2012.Studies were selected according to the specified inclusion and exclusion criteria and then subjected to methodological quality assessment,data extraction,and meta-analysis according to the Cochrane Handbook for Systematic Reviews of Interventions.RESULTS:Twelve RCTs involving 881 patients with AIDS were included.Methodological quality assessment showed that two were high-quality,two were moderate-quality,and eight were low-quality.Meta-analysis showed that TCM interventions were associated with significantly reduced plasma viral load compared with placebo[odds ratio OR=2.46,95%confidence interval CI(1.02,5.94);P=0.04].However,the reductions in plasma viral load significantly favored conventional Western medical therapy alone over integrated traditional Chinese and Western medical therapy[OR=0.16,95%CI(0.05,0.55);P=0.004].Patients receiving TCM interventions had significantly higher CD4+T lymphocyte counts compared with those on placebo[OR=2.54,95%CI(1.40,4.60);P=0.002].In addition,TCM interventions were significantly more likely to have improved clinical symptoms[OR=2.82,95%CI(1.85,4.31);P<0.00001].TCM interventions conferred a similar risk of adverse events(AEs)compared with control interventions[OR=1.87,95%CI(0.58,6.01);P=0.29].CONCLUSION:Current evidence suggests that TCM interventions are significantly more effective than placebo in reducing plasma viral load and increasing CD4+T lymphocyte count in patients with AIDS.When compared with conventional Western medical therapy,TCM interventions were significantly less effective in reducing plasma viral load,although they were associated with a higher percentage of patients with improved symptoms.Patients receiving TCM interventions did not seem to be at an increased risk of AEs.
基金Supported by National Natural Science Foundation of China(No.8157089181272981)+2 种基金Beijing Natural Science Foundation(No.7151003)Capital Medical University Fundamental Clinical Research Cooperation Fund(No.16JL73)Beijing Municipal Administration of Hospitals’Ascent Plan(No.DFL20150201)
文摘AIM：To compare the clinical manifestation of cytomegalovirus（CMV）retinitis and microvascular retinopathy（MVR）in patients with acquired immunodeficiency syndrome（AIDS）in China.METHODS：A total of 93 consecutive patients with AIDS,including 41 cases of CMV retinitis and 52 cases of MVR were retrospectively reviewed.Highly active antiretroviral therapy（HAART）status was recorded.HIV and CMV immunoassay were also tested.CD4＋T-lymphocyte count and blood CMV-DNA test were performed in all patients.Aqueous humor CMV-DNA test was completed in 39patients.Ophthalmological examinations including best corrected visual acuity（BCVA,by International Standard Vision Chart）,intraocular pressure（IOP）,slit-lamp biomicroscopy,indirect ophthalmoscopy were performed.RESULTS：In MVR group,the anterior segment examination was normal in all patients with a mean BCVA of 0.93±0.13.Blood CMV-DNA was 0（0,269 000）and 42 patients（80.77%）did not receive HAART.In CMV retinitis group,13 patients（31.71%）had anterior segment abnormality.The mean BCVA was 0.64±0.35 and blood CMV-DNA was 3470（0,1 450 000）.Nineteen patients（46.34%）had not received HAART.MVR group and CMV retinitis group the positive rates of aqueous CMV-DNA were 0 and 50%,respectively.Two patients with MVR progressed to CMV retinitis during the follow-up period.CONCLUSION：In comparison of CMV,patients with MVR have relatively mild visual function impairment.Careful ophthalmological examination and close follow-up are mandatory,especially for patients who have systemic complications,positive CMV-DNA test and without received HAART.
