AIM:To investigate the etiology of ocular pathogens and to establish the various pathogens present in human immunodeficiency virus(HIV)patients with cytomegalovirus retinitis(CMVR).METHODS:A total of 17 HIV-infected p...AIM:To investigate the etiology of ocular pathogens and to establish the various pathogens present in human immunodeficiency virus(HIV)patients with cytomegalovirus retinitis(CMVR).METHODS:A total of 17 HIV-infected patients with concomitant eye disorders were enrolled.Patients were divided into CMVR group(10 patients,18 eyes)and non-CMVR group(7 patients,9 eyes)based on clinical manifestations and the presence of cytomegalovirus(CMV)-DNA in ocular specimens.The viral load of CMV was assessed using polymerase chain reaction in aqueous humor,vitreous fluid,and peripheral blood samples of patients in the CMVR group.Additionally,peripheral blood CD4^(+)T cell counts were measured in both groups.RESULTS:In the CMVR group,the CMV-DNA load in the vitreous and aqueous humor samples was substantially higher than in the peripheral blood samples(P<0.01).CMVDNA load in the aqueous humor and vitreous samples of the two eyes in the CMVR group was determined to be statistically significant(10 patients,16 eyes,P=0.018,0.012).Peripheral blood CD4^(+)T cell counts in the CMVR group were adversely linked with the CMV-DNA load in both the aqueous humor and peripheral blood(P=0.005,0.048).Compared with the non-CMVR group,the peripheral blood CD4^(+)T cell count in the CMVR group decreased significantly(P=0.014).The peripheral blood CD4^(+)T cell count exceeded 300 cells/μL in 85.71%of non-CMVR patients,whereas it was below 100 cells/μL in 90.00%of the CMVR group.The intraocular specimens of the patients who underwent CMVR testing did not include any additional infections.CONCLUSION:In HIV-associated CMVR patients,there may exist alternative,yet unidentified,infection pathways for intraocular CMV in addition to the conventional route.The substantial difference in CMV-DNA load between the eyes of most CMVR patients suggests that CMV may originate from different sources in each eye.The proportion of peripheral blood CD4^(+)T cells in HIV patients is negatively correlated with the quantity of CMV viruses in their eyes.The peripheral blood count of<100 cells/μL indicates a considerable increase in the risk of concurrent CMVR.Multi-ocular pathogen presentations are uncommon in HIV individuals with CMVR.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
BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
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
Objectives:This study aimed to describe the development process of the peer precision-matching and health management mobile platform"Aspark"for people living with human immunodeficiency virus(HIV)(PLWH)and t...Objectives:This study aimed to describe the development process of the peer precision-matching and health management mobile platform"Aspark"for people living with human immunodeficiency virus(HIV)(PLWH)and to evaluate its usability.Methods:The study assembled a multidisciplinary research and development team comprising researchers,software engineers,art designers,clinical nursing specialists,HIV peer volunteers,and psychological counselors.The team employed an agile development model to iteratively build the platform.Using the social determinants of health framework and the interpersonal circumplex,we identified 14 matching variables for the mobile platform.A video production team was formed to create peer training videos on health management for PLWH.We integrated relevant tools to provide PLWH with various types of support,including informational,instrumental,emotional,affiliational,and appraisal assistance.From March to May 2024,the research team used convenience sampling to select 130 platform users.It administered an electronic questionnaire based on the System Usability Scale to evaluate the platform's overall usability.Results:The platform incorporates multiple functional modules,including"Precision Matching,""Drug Interaction Query,""Medication Reminder,""Health Management,""Mood Diary,""Community Discussion,"and"Activity Center,"achieving comprehensive coverage across informational,emotional,instrumental,social,and appraisal support.The precision matching module facilitates intelligent pairing between patients and peer volunteers;the health management module allows for the entry of test results and trend analysis;medication reminders and check-in features enhance medication adherence;the mood diary supports emotional recording and expressive writing;while the community module offers functions such as topic discussions,appointment scheduling,and organization of offline activities.Among the 130 valid questionnaires,more than 83%of users scored above 68 on the System Usability Scale,indicating that the platform demonstrates favourable usability.Conclusions:The"Aspark"platform offers a feasible and promising digital solution for precision matching in HIV peer support and health management,enabling healthcare providers to deliver personalized and continuous health support to patients through its functions.Well-designed clinical trials should be conducted in the future to evaluate the effectiveness of this tool.展开更多
A recent discovery in rice has revealed an elegant trick of nature:crops can teach their later generations to survive the cold through inherited memories written in chemical marks on the DNA letters,representing the f...A recent discovery in rice has revealed an elegant trick of nature:crops can teach their later generations to survive the cold through inherited memories written in chemical marks on the DNA letters,representing the first clear demonstration of what scientists call the“inheritance of acquired characteristics”-a phenomenon that biologists have debated for over two centuries.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
Debate regarding the premature aging of knee joints in acquired immune deficiency syndrome(AIDS)patients has remained contentious,with conjectures pointing towards its correlation with distinct antiviral regimes.Prote...Debate regarding the premature aging of knee joints in acquired immune deficiency syndrome(AIDS)patients has remained contentious,with conjectures pointing towards its correlation with distinct antiviral regimes.Protease inhibitors(PIs)stand as a prominent class of antiviral agents frequently utilized in AIDS management and have been significantly linked to premature senescence.This study aimed to investigate whether PI-containing regimens would accelerate osteoarthritis(OA)development and explore the molecular mechanisms underlying this association.A retrospective cohort of 151 HIV-infected individuals,categorized into PI and non-PI groups,was established.Patients in PI group exhibited lower KOOS and a higher prevalence of radiological knee OA than those in non-PI group.Additionally,25 anti-HIV drugs were screened and among all antiviral drugs,lopinavir had the most detrimental impact on cartilage anabolism,accelerating cartilage senescence and promoting mouse OA development.Mechanistically,lopinavir accelerated cellular senescence by inhibiting Zmpste24 and interfering nuclear membrane stability,which leads to decreased binding between nuclear membrane-binding protein Usp7 and Mdm2 and activates Usp7/Mdm2/p53 pathway.Zmpste24 overexpression reduces OA severity in mice.These findings suggest that PI-containing regimens accelerate cartilage senescence and OA development through Zmpste24 inhibition,which provides new insights into the selection of HIV regimens.展开更多
Over the past 2 decades,remarkable advancements in the screening,diagnosis,and treatment of non-small cell lung cancer(NSCLC)have led to improved patient outcomes.For the treatment of NSCLC with actionable gene mutati...Over the past 2 decades,remarkable advancements in the screening,diagnosis,and treatment of non-small cell lung cancer(NSCLC)have led to improved patient outcomes.For the treatment of NSCLC with actionable gene mutations,tyrosine kinase inhibitors developed against EGFR,ALK,RET,BRAF,ROS1,NTRK,MET,and KRAS,exhibit substantial antitumor activity and have been incorporated into standard treatment regimens.Additionally,numerous novel therapies,including immunotherapy and antibody-drug conjugate therapy,have been found to benefit patients with NSCLC.This review summarizes current advancements in targeted therapy for NSCLC,according to a systematic search of the PubMed database and synthesis of cutting-edge findings presented at the 2024 American Society of Clinical Oncology Annual Meeting and 2024 World Conference on Lung Cancer.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
Plantshave evolvedvariousmechanismsto interact withmicroorganisms,which help them acquire nutrients from the soil and enhance their tolerance to environmental stresses.One of the most widespread mutualistic interactio...Plantshave evolvedvariousmechanismsto interact withmicroorganisms,which help them acquire nutrients from the soil and enhance their tolerance to environmental stresses.One of the most widespread mutualistic interactions is arbuscular mycorrhizal(AM)symbiosis,which is formed by 80%-90%of terrestrial plants in association with AM fungi.In AM symbiosis,plants acquire mineral nutrients from the fungi in exchange for fatty acids and sugars that are produced during photosynthesis(Jiang et al.,2017).展开更多
BACKGROUND A recently developed method enables automated measurement of the hallux valgus angle(HVA)and the first intermetatarsal angle(IMA)from weightbearing foot radiographs.This approach employs bone segmentation t...BACKGROUND A recently developed method enables automated measurement of the hallux valgus angle(HVA)and the first intermetatarsal angle(IMA)from weightbearing foot radiographs.This approach employs bone segmentation to identify anatomical landmarks and provides standardized angle measurements based on established guidelines.While effective for HVA and IMA,preoperative radiograph analysis remains complex and requires additional measurements,such as the hallux interphalangeal angle(IPA),which has received limited research attention.AIM To expand the previous method,which measured HVA and IMA,by incorporating the automatic measurement of IPA,evaluating its accuracy and clinical relevance.METHODS A preexisting database of manually labeled foot radiographs was used to train a U-Net neural network for segmenting bones and identifying landmarks necessary for IPA measurement.Of the 265 radiographs in the dataset,161 were selected for training and 20 for validation.The U-Net neural network achieves a high mean Sørensen-Dice index(>0.97).The remaining 84 radiographs were used to assess the reliability of automated IPA measurements against those taken manually by two orthopedic surgeons(OA and OB)using computer-based tools.Each measurement was repeated to assess intraobserver(OA1 and OA2)and interobserver(O_(A2) and O_(B))reliability.Agreement between automated and manual methods was evaluated using the Intraclass Correlation Coefficient(ICC),and Bland-Altman analysis identified systematic differences.Standard error of measurement(SEM)and Pearson correlation coefficients quantified precision and linearity,and measurement times were recorded to evaluate efficiency.RESULTS The artificial intelligence(AI)-based system demonstrated excellent reliability,with ICC3.1 values of 0.92(AI vs OA2)and 0.88(AI vs O_(B)),both statistically significant(P<0.001).For manual measurements,ICC values were 0.95(OA2 vs OA1)and 0.95(OA2 vs OB),supporting both intraobserver and interobserver reliability.Bland-Altman analysis revealed minimal biases of:(1)1.61°(AI vs O_(A2));and(2)2.54°(AI vs O_(B)),with clinically acceptable limits of agreement.The AI system also showed high precision,as evidenced by low SEM values:(1)1.22°(O_(A2) vs O_(B));(2)1.77°(AI vs O_(A2));and(3)2.09°(AI vs O_(B)).Furthermore,Pearson correlation coefficients confirmed strong linear relationships between automated and manual measurements,with r=0.85(AI vs O_(A2))and r=0.90(AI vs O_(B)).The AI method significantly improved efficiency,completing all 84 measurements 8 times faster than manual methods,reducing the time required from an average 36 minutes to just 4.5 minutes.CONCLUSION The proposed AI-assisted IPA measurement method shows strong clinical potential,effectively corresponding with manual measurements.Integrating IPA with HVA and IMA assessments provides a comprehensive tool for automated forefoot deformity analysis,supporting hallux valgus severity classification and preoperative planning,while offering substantial time savings in high-volume clinical settings.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
基金Supported by the Self-funded Research Project of the Health and Family Planning Commission of Guangxi Zhuang Autonomous Region(No.Z2016325).
文摘AIM:To investigate the etiology of ocular pathogens and to establish the various pathogens present in human immunodeficiency virus(HIV)patients with cytomegalovirus retinitis(CMVR).METHODS:A total of 17 HIV-infected patients with concomitant eye disorders were enrolled.Patients were divided into CMVR group(10 patients,18 eyes)and non-CMVR group(7 patients,9 eyes)based on clinical manifestations and the presence of cytomegalovirus(CMV)-DNA in ocular specimens.The viral load of CMV was assessed using polymerase chain reaction in aqueous humor,vitreous fluid,and peripheral blood samples of patients in the CMVR group.Additionally,peripheral blood CD4^(+)T cell counts were measured in both groups.RESULTS:In the CMVR group,the CMV-DNA load in the vitreous and aqueous humor samples was substantially higher than in the peripheral blood samples(P<0.01).CMVDNA load in the aqueous humor and vitreous samples of the two eyes in the CMVR group was determined to be statistically significant(10 patients,16 eyes,P=0.018,0.012).Peripheral blood CD4^(+)T cell counts in the CMVR group were adversely linked with the CMV-DNA load in both the aqueous humor and peripheral blood(P=0.005,0.048).Compared with the non-CMVR group,the peripheral blood CD4^(+)T cell count in the CMVR group decreased significantly(P=0.014).The peripheral blood CD4^(+)T cell count exceeded 300 cells/μL in 85.71%of non-CMVR patients,whereas it was below 100 cells/μL in 90.00%of the CMVR group.The intraocular specimens of the patients who underwent CMVR testing did not include any additional infections.CONCLUSION:In HIV-associated CMVR patients,there may exist alternative,yet unidentified,infection pathways for intraocular CMV in addition to the conventional route.The substantial difference in CMV-DNA load between the eyes of most CMVR patients suggests that CMV may originate from different sources in each eye.The proportion of peripheral blood CD4^(+)T cells in HIV patients is negatively correlated with the quantity of CMV viruses in their eyes.The peripheral blood count of<100 cells/μL indicates a considerable increase in the risk of concurrent CMVR.Multi-ocular pathogen presentations are uncommon in HIV individuals with CMVR.
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Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
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funded by the National Natural Science Foundation of China(72204006).
文摘Objectives:This study aimed to describe the development process of the peer precision-matching and health management mobile platform"Aspark"for people living with human immunodeficiency virus(HIV)(PLWH)and to evaluate its usability.Methods:The study assembled a multidisciplinary research and development team comprising researchers,software engineers,art designers,clinical nursing specialists,HIV peer volunteers,and psychological counselors.The team employed an agile development model to iteratively build the platform.Using the social determinants of health framework and the interpersonal circumplex,we identified 14 matching variables for the mobile platform.A video production team was formed to create peer training videos on health management for PLWH.We integrated relevant tools to provide PLWH with various types of support,including informational,instrumental,emotional,affiliational,and appraisal assistance.From March to May 2024,the research team used convenience sampling to select 130 platform users.It administered an electronic questionnaire based on the System Usability Scale to evaluate the platform's overall usability.Results:The platform incorporates multiple functional modules,including"Precision Matching,""Drug Interaction Query,""Medication Reminder,""Health Management,""Mood Diary,""Community Discussion,"and"Activity Center,"achieving comprehensive coverage across informational,emotional,instrumental,social,and appraisal support.The precision matching module facilitates intelligent pairing between patients and peer volunteers;the health management module allows for the entry of test results and trend analysis;medication reminders and check-in features enhance medication adherence;the mood diary supports emotional recording and expressive writing;while the community module offers functions such as topic discussions,appointment scheduling,and organization of offline activities.Among the 130 valid questionnaires,more than 83%of users scored above 68 on the System Usability Scale,indicating that the platform demonstrates favourable usability.Conclusions:The"Aspark"platform offers a feasible and promising digital solution for precision matching in HIV peer support and health management,enabling healthcare providers to deliver personalized and continuous health support to patients through its functions.Well-designed clinical trials should be conducted in the future to evaluate the effectiveness of this tool.
文摘A recent discovery in rice has revealed an elegant trick of nature:crops can teach their later generations to survive the cold through inherited memories written in chemical marks on the DNA letters,representing the first clear demonstration of what scientists call the“inheritance of acquired characteristics”-a phenomenon that biologists have debated for over two centuries.
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.
基金supported by Natural Science Foundation of China(82472476)Fundamental Research Funds for the Central Universities(YG2023ZD15)+2 种基金The Youth Talent Program from Shanghai Health System(2022YQ020)AI-Driven Reform of Research Paradigms Empowers Discipline Advancement Initiatives from Shanghai Municipal Education Commission(Grant No.JWAIZD-7)the Natural Science Foundation of Shanghai(23ZR1437300).
文摘Debate regarding the premature aging of knee joints in acquired immune deficiency syndrome(AIDS)patients has remained contentious,with conjectures pointing towards its correlation with distinct antiviral regimes.Protease inhibitors(PIs)stand as a prominent class of antiviral agents frequently utilized in AIDS management and have been significantly linked to premature senescence.This study aimed to investigate whether PI-containing regimens would accelerate osteoarthritis(OA)development and explore the molecular mechanisms underlying this association.A retrospective cohort of 151 HIV-infected individuals,categorized into PI and non-PI groups,was established.Patients in PI group exhibited lower KOOS and a higher prevalence of radiological knee OA than those in non-PI group.Additionally,25 anti-HIV drugs were screened and among all antiviral drugs,lopinavir had the most detrimental impact on cartilage anabolism,accelerating cartilage senescence and promoting mouse OA development.Mechanistically,lopinavir accelerated cellular senescence by inhibiting Zmpste24 and interfering nuclear membrane stability,which leads to decreased binding between nuclear membrane-binding protein Usp7 and Mdm2 and activates Usp7/Mdm2/p53 pathway.Zmpste24 overexpression reduces OA severity in mice.These findings suggest that PI-containing regimens accelerate cartilage senescence and OA development through Zmpste24 inhibition,which provides new insights into the selection of HIV regimens.
基金funded by the National Natural Science Foundation of China(Grant no.82172776)Tianjin Health Research Project(Grant no.TJWJ2023XK005)Tianjin Science and Technology Plan Project(Grant no.24ZXGZSY00010).
文摘Over the past 2 decades,remarkable advancements in the screening,diagnosis,and treatment of non-small cell lung cancer(NSCLC)have led to improved patient outcomes.For the treatment of NSCLC with actionable gene mutations,tyrosine kinase inhibitors developed against EGFR,ALK,RET,BRAF,ROS1,NTRK,MET,and KRAS,exhibit substantial antitumor activity and have been incorporated into standard treatment regimens.Additionally,numerous novel therapies,including immunotherapy and antibody-drug conjugate therapy,have been found to benefit patients with NSCLC.This review summarizes current advancements in targeted therapy for NSCLC,according to a systematic search of the PubMed database and synthesis of cutting-edge findings presented at the 2024 American Society of Clinical Oncology Annual Meeting and 2024 World Conference on Lung Cancer.
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 the National Key R&D Program of China(2022YFF1001800)the National Natural Science Foundation of China(32088102)the Strategic Priority Research Program of the Chinese Academy of Sciences(XDB0630103).
文摘Plantshave evolvedvariousmechanismsto interact withmicroorganisms,which help them acquire nutrients from the soil and enhance their tolerance to environmental stresses.One of the most widespread mutualistic interactions is arbuscular mycorrhizal(AM)symbiosis,which is formed by 80%-90%of terrestrial plants in association with AM fungi.In AM symbiosis,plants acquire mineral nutrients from the fungi in exchange for fatty acids and sugars that are produced during photosynthesis(Jiang et al.,2017).
文摘BACKGROUND A recently developed method enables automated measurement of the hallux valgus angle(HVA)and the first intermetatarsal angle(IMA)from weightbearing foot radiographs.This approach employs bone segmentation to identify anatomical landmarks and provides standardized angle measurements based on established guidelines.While effective for HVA and IMA,preoperative radiograph analysis remains complex and requires additional measurements,such as the hallux interphalangeal angle(IPA),which has received limited research attention.AIM To expand the previous method,which measured HVA and IMA,by incorporating the automatic measurement of IPA,evaluating its accuracy and clinical relevance.METHODS A preexisting database of manually labeled foot radiographs was used to train a U-Net neural network for segmenting bones and identifying landmarks necessary for IPA measurement.Of the 265 radiographs in the dataset,161 were selected for training and 20 for validation.The U-Net neural network achieves a high mean Sørensen-Dice index(>0.97).The remaining 84 radiographs were used to assess the reliability of automated IPA measurements against those taken manually by two orthopedic surgeons(OA and OB)using computer-based tools.Each measurement was repeated to assess intraobserver(OA1 and OA2)and interobserver(O_(A2) and O_(B))reliability.Agreement between automated and manual methods was evaluated using the Intraclass Correlation Coefficient(ICC),and Bland-Altman analysis identified systematic differences.Standard error of measurement(SEM)and Pearson correlation coefficients quantified precision and linearity,and measurement times were recorded to evaluate efficiency.RESULTS The artificial intelligence(AI)-based system demonstrated excellent reliability,with ICC3.1 values of 0.92(AI vs OA2)and 0.88(AI vs O_(B)),both statistically significant(P<0.001).For manual measurements,ICC values were 0.95(OA2 vs OA1)and 0.95(OA2 vs OB),supporting both intraobserver and interobserver reliability.Bland-Altman analysis revealed minimal biases of:(1)1.61°(AI vs O_(A2));and(2)2.54°(AI vs O_(B)),with clinically acceptable limits of agreement.The AI system also showed high precision,as evidenced by low SEM values:(1)1.22°(O_(A2) vs O_(B));(2)1.77°(AI vs O_(A2));and(3)2.09°(AI vs O_(B)).Furthermore,Pearson correlation coefficients confirmed strong linear relationships between automated and manual measurements,with r=0.85(AI vs O_(A2))and r=0.90(AI vs O_(B)).The AI method significantly improved efficiency,completing all 84 measurements 8 times faster than manual methods,reducing the time required from an average 36 minutes to just 4.5 minutes.CONCLUSION The proposed AI-assisted IPA measurement method shows strong clinical potential,effectively corresponding with manual measurements.Integrating IPA with HVA and IMA assessments provides a comprehensive tool for automated forefoot deformity analysis,supporting hallux valgus severity classification and preoperative planning,while offering substantial time savings in high-volume clinical settings.
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.
