BACKGROUND Acute disseminated encephalomyelitis(ADEM),which is rare,primarily affects children.It usually manifests as acute encephalopathy and multifocal neurological impairments after infection or vaccination.Diagno...BACKGROUND Acute disseminated encephalomyelitis(ADEM),which is rare,primarily affects children.It usually manifests as acute encephalopathy and multifocal neurological impairments after infection or vaccination.Diagnosis is still difficult due to the clinical and radiological similarity to other central nervous system disorders.Adult-onset ADEM calls for thorough reporting in order to improve diagnosis and treatment.CASE SUMMARY A 55-year-old man with hypertension had a high fever,intense headache and a steady decline in his neurological function after two weeks.Left facial paralysis was the initial symptom,which progressed to left hemiparesis,reduced consciousness level,photophobia,phonophobia,vomiting,and a focal seizure in the right leg.He had no history of autoimmune disease,vaccinations,or infections.Investigations showed negative infectious/autoimmune serology,mild cerebrospinal fluid lymphocytic pleocytosis(protein 76 mg/dL),and lymphopenia.Brain magnetic resonance imaging without contrast revealed bilateral,symmetrical T2/fluid-attenuated inversion recovery hyperintensities,primarily in the middle cerebellar peduncles,with minor involvement in the pontine and periventricular regions.Neoplastic,metabolic,vascular,and infectious conditions were not included.The patient showed spontaneous neurological improvement by Week 3 with near-complete motor recovery(limb strength 4/5)after methylprednisolone and rehabilitation,despite logistical delays in starting immunotherapy.The monophasic course and radiological/clinical remission were supported by idiopathic ADEM.CONCLUSION This case shows an uncommon,idiopathic,cerebellar-predominant ADEM variation in an adult without conventional triggers.It emphasizes the diagnostic difficulty in distinguishing ADEM from mimics(such as stroke or infection)in adults.Spontaneous improvement before treatment,although early detection is still crucial,should be highlighted,although early detection is still crucial.Increased clinician awareness,fair access to neuroimaging,and focused research on adult ADEM are crucial to fill these gaps and improve outcomes in places with limited resources.展开更多
BACKGROUND Erythrodermic psoriasis(EP)is a rare and life-threatening form of psoriasis associated with significant morbidity and mortality.Systemic immunosuppre-ssive therapies are often required but may predispose to...BACKGROUND Erythrodermic psoriasis(EP)is a rare and life-threatening form of psoriasis associated with significant morbidity and mortality.Systemic immunosuppre-ssive therapies are often required but may predispose to opportunistic infections.Disseminated herpes simplex virus type-1(HSV-1)is an unusual complication in otherwise immunocompetent patients and has not been reported in association with ixekizumab therapy for EP.CASE SUMMARY We describe a 49-year-old man with longstanding severe plaque psoriasis,liver cirrhosis,and bipolar disorder who developed EP involving>90%of body surface area[Psoriasis Area and Severity Index(PASI)45].Following initial stabil-ization,he was admitted to the intensive care unit(ICU)with hemodynamic instability,leukocytosis with eosinophilia,and diffuse desquamation.Ixekizumab was initiated with high-dose topical clobetasol.During his ICU stay,he developed recurrent bacteremias and neurologic decline(Glasgow Coma Scale 7/15),fo-llowed by the appearance of widespread vesicles and hemorrhagic crusts.HSV-1 infection was confirmed by polymerase chain reaction(PCR).Immunosuppressive therapy was withheld,and intravenous acyclovir was started,leading to progre-ssive improvement.After ten days,ixekizumab was reintroduced with careful monitoring,resulting in marked clinical improvement(PASI 9.7 at six weeks).The patient remained stable on long-term follow-up with oral acyclovir prophylaxis.CONCLUSION This case highlights the diagnostic and therapeutic challenges of managing EP in the setting of biologic therapy.Disseminated cutaneous HSV-1 should be considered in immunosuppressed patients presenting with new vesicular eruptions,and prompt PCR testing with early antiviral therapy is essential.A multidisciplinary approach is critical to balance immunosuppression for disease control with infection risk.展开更多
BACKGROUND Histoplasmosis is a rare infectious condition with mainly pulmonary involvement which is generally self-limiting in immunocompetent individuals.Its manifestation varies and lacks specificity.This study repo...BACKGROUND Histoplasmosis is a rare infectious condition with mainly pulmonary involvement which is generally self-limiting in immunocompetent individuals.Its manifestation varies and lacks specificity.This study reports a case of primary disseminated liver histoplasmosis in a normal host presenting as liver failure cured by liver transplantation and voriconazole.CASE SUMMARY A 43-year-old Chinese man with intermittent fever,malaise,jaundice and extreme hepatomegaly for more than 40 days was admitted to the Second Xiang-ya Hospital.The patient was immunocompetent and lacked a definitive history of exposure.His condition deteriorated to liver failure,and he promptly underwent liver transplantation to ensure survival.One year later,the patient presented with severe gastrointestinal symptoms,including fever,abdominal pain,and diarrhea.Subsequently,tissue samples acquired via gastrointestinal endoscopy were subjected to pathological examination and next-generation sequencing analysis.Through a comprehensive amalgamation of clinical presentation,biopsy pathology,and next-generation sequencing analysis,the patient was ultimately diagnosed with disseminated hepatic histoplasmosis.The patient achieved complete recovery after 6 months of voriconazole treatment.CONCLUSION In patients with chronic-hepatitis-B having atypical symptoms,histoplasmosis can be a differential diagnosis.Voriconazole is effective in treating histoplasmosis.展开更多
Disseminated mucormycosis is a life-threatening fungal infection with high mortality,particularly in immunocompromised patients.Early diagnosis and prompt intervention are crutial but often delayed due to nonspecific ...Disseminated mucormycosis is a life-threatening fungal infection with high mortality,particularly in immunocompromised patients.Early diagnosis and prompt intervention are crutial but often delayed due to nonspecific presentations.Many studies have highlighted the challenges in emergency settings,where atypical symptoms may lead to misdiagnosis.We report a rare case of disseminated mucormycosis originating from the stomach in a pregnancy-induced thrombocytopenia(PITP)patient,emphasizing rapid gastroscopy examination,histopathological confi rmation,multidisciplinary management,and high-risk factors for hospital-acquired gastrointestinal mucormycosis infection.展开更多
This paper is focused on discussing the case of Las Loras UNESCO Global Geopark,in Spain,as an example to show the contribution of Geoparks to the dissemination of science and the relevance of preserving geoheritage b...This paper is focused on discussing the case of Las Loras UNESCO Global Geopark,in Spain,as an example to show the contribution of Geoparks to the dissemination of science and the relevance of preserving geoheritage by implementing simple measures based on communication and prevention.Natural and anthropic hazards derived from climate change are endangering heritage and the well-ness of the society.Geoheritage is vulnerable.Nowadays we are witnessing the destruction of monuments with high emotional significance due to wars,but climate change is also contributing to the loss of the same cultural heritage.Prevention is often the best way to protect geoheritage from disappearing and society is the best agent to implement preventive measures.Citizens are often unaware of the important treasures they have around them.Geoparks have been a great tool to bring awareness in society,since by involving the public in the whole process of recognition and promotion,they protect the space and the cultural and economic values associated with them.It is important to communicate the initiatives taking place in the Geoparks to explain the importance of geology and the risk of losing the geoheritage if natural hazards increase.Las Loras study is a good practice to implement in other Geoparks.展开更多
BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis patients.In this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-assoc...BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis patients.In this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-associated coagulopathy(SAC)criteria in identifying overt-DIC and preDIC status in sepsis patients.METHODS:Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022.The performances of the SIC and SAC were assessed to identify overt-DIC on days 1,3,7,or 14.The SIC status or SIC score on day 1,the SAC status or SAC score on day 1,and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC.The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation.RESULTS:On day 1,the incidences of coagulopathy according to overt-DIC,SIC and SAC criteria were 11.7%,22.0%and 31.5%,respectively.The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14(P<0.05).On day 1,the SIC score with a cut-off value>3 had a significantly higher sensitivity(72.00%)and area under the curve(AUC)(0.69)in identifying pre-DIC than did the SIC or SAC status(sensitivity:SIC status 44.00%,SAC status 52.00%;AUC:SIC status 0.62,SAC status 0.61).The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC(0.79 vs.0.69,P<0.001).Favorable effects of anticoagulant therapy were observed in SIC(adjusted hazard ratio[HR]=0.216,95%confidence interval[95%CI]:0.060–0.783,P=0.018)and SAC(adjusted HR=0.146,95%CI:0.041–0.513,P=0.003).CONCLUSION:The SIC and SAC seem to be valuable for predicting overt-DIC.The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.展开更多
Objective:To summarize the clinical characteristics and treatment plan for a case of disseminated nocardiosis.Methods:The study summarized the clinical characteristics and treatment plan for a case of disseminated noc...Objective:To summarize the clinical characteristics and treatment plan for a case of disseminated nocardiosis.Methods:The study summarized the clinical characteristics and treatment plan for a case of disseminated nocardiosis.Results:The primary symptoms of the patient included high fever and multiple enlarged lymph nodes.Chest computed tomography revealed a shadow of nodules in the upper lobe of the left lung,multiple nodules,and pleural effusion in both lungs.Additionally,bilateral blood cultures indicated the presence of Nocardia terpenica.The final diagnosis was disseminated Nocardia sp.infection.Upon admission,anti-infective treatment was initiated with sulfamethoxazole and linezolid.Conclusion:In patients with normal immune function,disseminated nocardiosis may present as high fever with lymph node enlargement,necessitating differentiation from lymphoma.This study reports on the diagnosis and treatment plan of a case of disseminated nocardiosis to enhance understanding and clinical management of this disease.展开更多
Objective:Lung adenocarcinoma exhibits diverse genetic and morphological backgrounds,in addition to considerable differences in clinical pathology and molecular biological characteristics.Among these,the phenomenon of...Objective:Lung adenocarcinoma exhibits diverse genetic and morphological backgrounds,in addition to considerable differences in clinical pathology and molecular biological characteristics.Among these,the phenomenon of spread through air space(STAS),a distinct mode of lung cancer infiltration,has rarely been reported.Therefore,this study aimed to explore the relationship between STAS tumor cells and the clinical and molecular characteristics of patients with lung adenocarcinoma,as well as their impact on prognosis.Methods:This study included 147 patients who were diagnosed with lung adenocarcinoma at the Inner Mongolia Autonomous Region Cancer Institute between January 2014 and December 2017.Surgical resection specimens were retrospectively analyzed.Using univariate and multivariate Cox analyses,we assessed the association between STAS and the clinicopathological features and molecular characteristics of patients with lung adenocarcinoma.Furthermore,we investigated the effects on patient prognosis.In addition,we developed a column–line plot prediction model and performed internal validation.Results:Patients with positive STAS had a significantly higher proportion of tumors with a diameter≥2 cm,with infiltration around the pleura,blood vessels,and nerves,and a pathological stage>IIB than in STAS-negative patients(P<0.05).Cox multivariate survival analysis revealed that clinical stage,STAS status,tumor size,and visceral pleural invasion were independent prognostic factors influencing the 5-year progression-free survival in patients with lung adenocarcinoma.The predictive values and P values from the Hosmer-Lemeshow test were 0.8 and 0.2,respectively,indicating no statistical difference.Receiver operating characteristic curve analysis demonstrated areas under the curve of 0.884 and 0.872 for the training and validation groups,respectively.The nomogram model exhibited the best fit with a value of 192.09.Conclusions:Clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis are independent prognostic factors for patients with STAS-positive lung adenocarcinoma.The nomogrambased on the clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis showed good accuracy,differentiation,and clinical practicality.展开更多
Coagulation abnormalities, such as disseminated intravascular coagulation （DIC）, are associated with progressive hemcrrhagic injury （PHI） following head trauma. However, the exact relationship between coagulopathy...Coagulation abnormalities, such as disseminated intravascular coagulation （DIC）, are associated with progressive hemcrrhagic injury （PHI） following head trauma. However, the exact relationship between coagulopathy and PHI remains unclear. The present study utilized a scoring system defined by the International Society of Thrombosis and Haemostasis to investigate whether a high DIC score is predictive for PHI. This study was a multicenter prospective design involving four hospitals, a 6-month observation, and follow-up. Of 352 traumatic brain injury （TBI） patients, serial CT scan indicated approximately one third of patients developed progressive hemorrhage, which was most frequently observed in the frontal, temporal, and orbitofrontal lobes of patients with brain contusion. PHI-positive patients exhibited poor prognosis, as indicated by prolonged length of hospital/intensive care unit stay and high mortality. More importantly, a DIC score after TBI, as well as patient age and sex, could serve as predictors for PHI. In addition, DIC scores were closely associated with injury severity. Therefore, the DIC scoring system facilitated early PHI diagnosis in TBI patients, and DIC scores might serve as a valuable predictor for TBI patients with PHI.展开更多
Disseminated carcinomatosis of the bone marrow is characterized by widespread bone metastasis(bone marrow infiltration) from solid tumors with hematological disorders coexisted. This disease is frequently complicated ...Disseminated carcinomatosis of the bone marrow is characterized by widespread bone metastasis(bone marrow infiltration) from solid tumors with hematological disorders coexisted. This disease is frequently complicated with gastric cancer among solid tumors although its incidence is very rare. In recent years,technological innovations in diagnosis and treatment for cancer have remarkably improved,which made survival rates of various cancers prolonged. Prognosis of disseminated carcinomatosis of the bone marrow associated with gastric cancer,however,is still poor(less than a year),possibly because this disease has not been given attention due to low incidence. In this review,I summarize the results obtained for the past,and propose ways to improve the prognosis of this disease.展开更多
Objective:To investigate whether atractylenolide Ⅰ(ATL-Ⅰ) has protective effect on lipopolysaccharide(LPS)-induced disseminated intravascular coagulation(DIC) in vivo and in vitro,and explore whether NF-κB signalin...Objective:To investigate whether atractylenolide Ⅰ(ATL-Ⅰ) has protective effect on lipopolysaccharide(LPS)-induced disseminated intravascular coagulation(DIC) in vivo and in vitro,and explore whether NF-κB signaling pathway is involved in ATL-Ⅰ treatment.Methods:New Zealand white rabbits were injected with LPS through marginal ear vein over a period of 6h at a rate of 600 μg/kg(10 mL/h).Similarly,in the treatment groups,1.0,2.0,or 5.0 mg/kg ATL-Ⅰ were given.Both survival rate and organ function were tested,including the level of alanine aminotransferase(ALT),blood urine nitrogen(BUN),and TNF-α were examined by ELISA.Also haemostatic and fibrinolytic parameters in serum were measured.RAW 264.7 macrophage cells were administered with control,LPS,LPS + ATL-Ⅰ and ATL-Ⅰ alone,and TNF-α,phosphorylation(P)-IκBα,phosphorylation(P)-NF-κB(P65) and NF-κB(P65) were determined by Western blot.Results:The administration of LPS resulted in 73.3%mortality rate,and the increase of serum TNF-α,BUN and ALT levels.When ATL-Ⅰ treatment significantly increased the survival rate of LPS-induced DIC model,also improved the function of blood coagulation.And protein analysis indicated that ATL-Ⅰ remarkably protected liver and renal as decreasing TNF-α expression.In vitro,ATL-Ⅰ obviously decreased LPS-induced TNF-αproduction and the expression of P-NF-κB(P65),with the decrease of P-IκBα.Conclusions:ATL-Ⅰ has protective effect on LPS-induced DIC,which can elevate the survival rate,reduce organ damage,improve the function of blood coagulation and suppress TNF-α expression by inhibiting the activation of NF-κB signaling pathway.展开更多
In this study,we used plasma factor V activity and parameters of the thrombin generation test to discuss their diagnostic and prognostic value for disseminated intravascular coagulation (DIC) in patients with hematolo...In this study,we used plasma factor V activity and parameters of the thrombin generation test to discuss their diagnostic and prognostic value for disseminated intravascular coagulation (DIC) in patients with hematological malignancies.A total of 164 patients who were diagnosed with hematological malignancies in the Department of Hematology,Union Hospital,between Apr 2014 and Dec.2014 were enrolled in this study.There were 131 patients in the study group and 33 patients in the control group in terms of the laboratory results for DIC.The patients in the study group were divided into a DIC subgroup (n=59) and a non-DIC subgroup (n=72) based on the International Society of Thrombosis and Hemostasis (ISTH) Integral System,and they were divided into four subgroups [score ≤3 (n=35),score=4 (n=37),score=5 (n=47),and score >6 (n=12)] according to ISTH scores.Using 28-day mortality as the endpoint,the patients in the study group were divided into a survival subgroup (n=111) and a non-survival subgroup (n=20).The results showed that the plasma factor V activity was significantly weaker,and lag time and time to peak were significantly shorter in the study group than in the control group (P<0.01).The factor V activity,peak and endogenous thrombin potential (ETP) were significantly decreased in the DIC subgroup as compared with those in the non-DIC subgroup (P<0.01).Among factor V activity,lag time,peak,ETP,and ttPeak,only the factor V activity was significantly decreased in the nonsurvival subgroup compared with the survival subgroup (P<0.01).With the increase in ISTH score,the ETP and peak decreased gradually.The binary logistic regression analysis revealed that PLT,D-dimer,factor V activity and ETP had linear relationship with DIC diagnosed by ISTH Integral System.Using DIC diagnosed by ISTH Integral System as the endpoint,the area under curve (AUC) of factor V activity was found to be similar to that of blood platelet count (PLT) and prothrombin time (PT).In conclusion,factor V activity,ETP and peak had diagnostic value for DIC in patients with hematological malignancies,and only factor V activity had limited prognostic value.展开更多
Orogenic disseminated and Carlin gold deposits share much similarity in alteration and mineralization.The disseminated orogenic Zhenyuan Au deposit along the Ailaoshan shear zone,southeastern Tibet,was selected to cla...Orogenic disseminated and Carlin gold deposits share much similarity in alteration and mineralization.The disseminated orogenic Zhenyuan Au deposit along the Ailaoshan shear zone,southeastern Tibet,was selected to clarify their difference.The alteration and mineralization from the different lithologies,including meta-quartz sandstone,carbonaceous slate,meta-(ultra)mafic rock,quartz porphyry and lamprophyre were researched.According to the mineral assemblage and replacement relationship in all types of host rocks,two reactions show general control on gold deposition:(1) replacement of earlier magnetite by pyrite and carbonaceous material;(2) alteration of biotite and phlogopite phenocrysts in quartz porphyry and lamprophyre into dolomite/ankerite and sericite.Despite the lamprophyre is volumetrically minor and much less fractured than other host rocks,it contains a large portion of Au reserve,indicating that the chemically active lithology has played a more important role in gold precipitation compared to structure.LA-ICP-MS analysis shows that Au mainly occurs as invisible gold in fine-grained pyrite disseminated in the host rocks,with Au content reaching to 258.95 ppm.The diagenetic core of pyrite in meta-quartz sandstone enriched in Co,Ni,Mo,Ag and Hg is wrapped by hydrothermal pyrite enriched in Cu,As,Sb,Au,Tl,Pb and Bi.Different host rock lithology has much impact on the alteration and mineralization features.Carbonate and sericite in altered lamprophyre show they have higher Mg than those developed in other of host rocks denoting that the carbonate and sericite incorporated Mg from phlogopite phenocrysts in the primary lamprophyre during alteration.The ore fluid activated the diagenetic pyrite in meta-quartz sandstone leading the hydrothermal pyrite enriched in Cu,Mo,Ag,Sb,Te,Hg,Tl,Pb and Bi,but the hydrothermal pyrite in meta-(ultra)mafic rock is enriched in Co and Ni as the meta-(ultra)mafic rock host rock contain high content of Co and Ni.However,Au and As shear similar range in both types of host rocks indicating that these two elements most likely come from the deep source fluid rather than the host rocks.It was shown in the disseminated orogenic gold deposit that similar hydrothermal alteration with mineral assemblage of carbonate (mainly dolomite and ankerite),sericite,pyrite and arsenopyrite develops in all types of host rocks.This is different from the Nevada Carlin type,in which alteration is mainly dissolution and silicification of carbonate host rock.On the other hand,Au mainly occur as invisible gold in both disseminated orogenic and Carlin gold deposits.展开更多
Sedimentary rock-hosted disseminated gold (SRHDG) deposits in the Youjiang-Nanpanjiang Basin, southwestern Guizhou Province are commonly hosted by the same fold crests that commonly contain a remarkable amount of orga...Sedimentary rock-hosted disseminated gold (SRHDG) deposits in the Youjiang-Nanpanjiang Basin, southwestern Guizhou Province are commonly hosted by the same fold crests that commonly contain a remarkable amount of organic material. The total organic carbon (TOC) contents of the ores and host rocks are usually less than 1%. The reflectance of vitrinite and pyrobitumen in the ores and the host rocks ranges from 1.5% to 4.5%, often in the range of 2% to 3%. In the Lannigou deposit, the reflectance of vitrinite and pyrobitumen in the ores is usually somewhat higher than those within the host rocks, indicating a hydrothermal impact on the organic matter in the altered host rocks. On the contrary, the estimated maximum paleotemperatures of the Getang and Zimudang deposits are higher than the homogenization temperatures of the fluid inclusions in the ores, signifying that the organic matter maturation predated Au mineralization. No correlation between the organic matter contents and Au concentrations were recognized in the ores. However, the most striking observation is that there is a positive correlation between the S2 (a parameter of Rock-Eval analysis), Au and As contents of the ores in the Lannigou deposit. Organic matter maturation and migration is apparent from the TOC vs. HCI diagram. Furthermore, group analysis of the dichloromethane extractable organic component of the ores and host rocks shows that the maturation degree of the organic matter in the ores is slightly higher than that of the host rocks in the Lannigou gold deposit. However, the compositions of their alkanes, steranes and terpenes, which serve as biomarkers, are quite similar; this suggests that the organic matter found in the ores and host rocks has a common marine source. Organic matter probably contributed to the preconcentration of Au in the host rocks. Hydrocarbons in the system, on the other hand, clearly contributed to the emplacement of the gold mineralization through thermal sulfate reduction. Organic matter in the solution might have increased the potential of the hydrothermal solution to transport Au.展开更多
AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-indu...AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P < 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P < 0.01, OR = 12, 95%CI: 2.3-60). Although the difference did not reach statistical significance, primary diseases(malignancies)(P = 0.055, OR = 3.9, 95%CI: 0.97-16) and the non-use of r TM had a tendency to be associated with persistent DIC(P = 0.08, OR = 4.3, 95%CI: 0.84-22).CONCLUSION: The add-on effects of r TM are anticipated in the treatment of AC-induced DIC, although biliary drainage for AC remains crucial.展开更多
BACKGROUND Visceral disseminated varicella-zoster virus(VZV)infection is a rare but lifethreatening disease.In transplant recipients with VZV infection,visceral dissemination may develop without skin eruptions,which l...BACKGROUND Visceral disseminated varicella-zoster virus(VZV)infection is a rare but lifethreatening disease.In transplant recipients with VZV infection,visceral dissemination may develop without skin eruptions,which leads to the failure of early diagnosis.CASE SUMMARY The patient was a 33-year-old male renal recipient who was referred to our hospital with severe upper abdominal pain of 3-d duration.On admission,the patient rapidly developed septic shock and multiple organ dysfunction syndrome with liver dysfunction and acute kidney injury.Next-generation sequencing of peripheral blood yielded 39224 sequence reads of VZV,and real-time polymerase chain reaction for VZV was positive,with 1.2×10^(7) copies/mL.The final diagnosis was visceral disseminated VZV infection.Acyclovir and supportive therapy were started,but the patient died of severe visceral organ damage 16 h after admission.CONCLUSION Visceral disseminated VZV infection is possible in renal transplant recipients presenting abdominal pain and rapidly-evolving organ damage without skin involvement.展开更多
Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts.Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for t...Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts.Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for two days.Diagnosis: Disseminated nocardiosis due to Nocardia otitidiscaviarum. Interventions: Initial antimicrobial therapy with imipenem and trimethoprim/sulfamethoxazole was switched to 6 weeks of trimethoprim/sulfamethoxazole, linezolid and tigecycline after sensitivity test results were available. Thereafter, the patient was switched to maintenance trimethoprim/sulfamethoxazole and moxifloxacin. Prednisolone was gradually tapered.Outcomes: Soft tissue swelling and pain disappeared and the patient was discharged uneventfully.Lessons: Disseminated nocardiosis due to Nocardia otitidiscaviarum should be suspected in immunocompetent hosts with risk factors such as medication with prednisolone. Early identification of the causative species and susceptibility results is crucial given the diverse resistance patterns amongst various Nocardia species.展开更多
Objective: To explore the therapeutic effect and mechanism of myricctin on disseminated intravascular coagulation(DIC). Methods: The DIC model was established by injection of60 mg/kg LPS in KM mice, and the treatment ...Objective: To explore the therapeutic effect and mechanism of myricctin on disseminated intravascular coagulation(DIC). Methods: The DIC model was established by injection of60 mg/kg LPS in KM mice, and the treatment groups were injected myricetin with different concentrations(25 or 50 mg/kg) 30 min before the model was established. Both coagulation indicators and organ function were tested, including PT, APTT, fibrinogen. AST, ALT. BUN and tissue section. In vitro, the inflammatory model of RAW 264.7 macrophage cells were established by 10 μg/mL LPS. The treatment group was treated with 50 μmol/mL myricetin for 30 min before LPS, and the expression of TNF-a and p-NF-KB was detected, further to explore the therapeutic mechanism. Results: LPS-induced DIC led to a reduction of fibrinogen and a rise of PT, APTT,AST, ALT, BUN levels, but the treatment of myricctin significantly inhibited these abnormalities. Histopathology analysis also revealed that myricetin remarkably protected the liver and renal damage. In vitro, the expression of TNF-α and p-NF-κB induced by LPS was repressed by myricetin. Conclusions: This study provides new insights into the protective effects of myricetin in LPS-induced DIC by anticoagulant and anti-inflammatory via suppressing the activation of p-NF-κB which decreased TNF-α level.展开更多
The symptoms of disseminated strongyloidiasis are not typical,and it is difficult for clinicians to identify strongyloidiasis in some non-endemic areas.We report a 70-year-old woman who was diagnosed with Guillain-Bar...The symptoms of disseminated strongyloidiasis are not typical,and it is difficult for clinicians to identify strongyloidiasis in some non-endemic areas.We report a 70-year-old woman who was diagnosed with Guillain-Barrésyndrome due to autonomic disturbance,symmetrical bulbar palsy,and lower-motor-nerve damage in the extremities;her symptoms continued to worsen after hormone and immunoglobulin therapy.Later,parasitic larvae were found in the patient’s gastric fluid,and metagenomic next generation sequencing(mNGS)detection of bronchoalveolar-lavage fluid also found a large number of Strongyloides roundworms.The patient was diagnosed with disseminated strongyloidiasis.The patient was given albendazole for anthelmintic treatment,but died two days after being transferred to the intensive care unit due to the excessive strongyloidiasis burden.In recent years,mNGS has been increasingly used in clinical practice,and is becoming the main means of detecting strongyloides stercoralis in non-endemic areas.Especially during the corona virus disease 2019 pandemic,mNGS technology has irreplaceable value in identifying the source of infection.展开更多
INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. Th...INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.展开更多
文摘BACKGROUND Acute disseminated encephalomyelitis(ADEM),which is rare,primarily affects children.It usually manifests as acute encephalopathy and multifocal neurological impairments after infection or vaccination.Diagnosis is still difficult due to the clinical and radiological similarity to other central nervous system disorders.Adult-onset ADEM calls for thorough reporting in order to improve diagnosis and treatment.CASE SUMMARY A 55-year-old man with hypertension had a high fever,intense headache and a steady decline in his neurological function after two weeks.Left facial paralysis was the initial symptom,which progressed to left hemiparesis,reduced consciousness level,photophobia,phonophobia,vomiting,and a focal seizure in the right leg.He had no history of autoimmune disease,vaccinations,or infections.Investigations showed negative infectious/autoimmune serology,mild cerebrospinal fluid lymphocytic pleocytosis(protein 76 mg/dL),and lymphopenia.Brain magnetic resonance imaging without contrast revealed bilateral,symmetrical T2/fluid-attenuated inversion recovery hyperintensities,primarily in the middle cerebellar peduncles,with minor involvement in the pontine and periventricular regions.Neoplastic,metabolic,vascular,and infectious conditions were not included.The patient showed spontaneous neurological improvement by Week 3 with near-complete motor recovery(limb strength 4/5)after methylprednisolone and rehabilitation,despite logistical delays in starting immunotherapy.The monophasic course and radiological/clinical remission were supported by idiopathic ADEM.CONCLUSION This case shows an uncommon,idiopathic,cerebellar-predominant ADEM variation in an adult without conventional triggers.It emphasizes the diagnostic difficulty in distinguishing ADEM from mimics(such as stroke or infection)in adults.Spontaneous improvement before treatment,although early detection is still crucial,should be highlighted,although early detection is still crucial.Increased clinician awareness,fair access to neuroimaging,and focused research on adult ADEM are crucial to fill these gaps and improve outcomes in places with limited resources.
文摘BACKGROUND Erythrodermic psoriasis(EP)is a rare and life-threatening form of psoriasis associated with significant morbidity and mortality.Systemic immunosuppre-ssive therapies are often required but may predispose to opportunistic infections.Disseminated herpes simplex virus type-1(HSV-1)is an unusual complication in otherwise immunocompetent patients and has not been reported in association with ixekizumab therapy for EP.CASE SUMMARY We describe a 49-year-old man with longstanding severe plaque psoriasis,liver cirrhosis,and bipolar disorder who developed EP involving>90%of body surface area[Psoriasis Area and Severity Index(PASI)45].Following initial stabil-ization,he was admitted to the intensive care unit(ICU)with hemodynamic instability,leukocytosis with eosinophilia,and diffuse desquamation.Ixekizumab was initiated with high-dose topical clobetasol.During his ICU stay,he developed recurrent bacteremias and neurologic decline(Glasgow Coma Scale 7/15),fo-llowed by the appearance of widespread vesicles and hemorrhagic crusts.HSV-1 infection was confirmed by polymerase chain reaction(PCR).Immunosuppressive therapy was withheld,and intravenous acyclovir was started,leading to progre-ssive improvement.After ten days,ixekizumab was reintroduced with careful monitoring,resulting in marked clinical improvement(PASI 9.7 at six weeks).The patient remained stable on long-term follow-up with oral acyclovir prophylaxis.CONCLUSION This case highlights the diagnostic and therapeutic challenges of managing EP in the setting of biologic therapy.Disseminated cutaneous HSV-1 should be considered in immunosuppressed patients presenting with new vesicular eruptions,and prompt PCR testing with early antiviral therapy is essential.A multidisciplinary approach is critical to balance immunosuppression for disease control with infection risk.
文摘BACKGROUND Histoplasmosis is a rare infectious condition with mainly pulmonary involvement which is generally self-limiting in immunocompetent individuals.Its manifestation varies and lacks specificity.This study reports a case of primary disseminated liver histoplasmosis in a normal host presenting as liver failure cured by liver transplantation and voriconazole.CASE SUMMARY A 43-year-old Chinese man with intermittent fever,malaise,jaundice and extreme hepatomegaly for more than 40 days was admitted to the Second Xiang-ya Hospital.The patient was immunocompetent and lacked a definitive history of exposure.His condition deteriorated to liver failure,and he promptly underwent liver transplantation to ensure survival.One year later,the patient presented with severe gastrointestinal symptoms,including fever,abdominal pain,and diarrhea.Subsequently,tissue samples acquired via gastrointestinal endoscopy were subjected to pathological examination and next-generation sequencing analysis.Through a comprehensive amalgamation of clinical presentation,biopsy pathology,and next-generation sequencing analysis,the patient was ultimately diagnosed with disseminated hepatic histoplasmosis.The patient achieved complete recovery after 6 months of voriconazole treatment.CONCLUSION In patients with chronic-hepatitis-B having atypical symptoms,histoplasmosis can be a differential diagnosis.Voriconazole is effective in treating histoplasmosis.
基金supported by a grant from Guangdong Provincial Natural Science Foundation of China(2023A15115012665).
文摘Disseminated mucormycosis is a life-threatening fungal infection with high mortality,particularly in immunocompromised patients.Early diagnosis and prompt intervention are crutial but often delayed due to nonspecific presentations.Many studies have highlighted the challenges in emergency settings,where atypical symptoms may lead to misdiagnosis.We report a rare case of disseminated mucormycosis originating from the stomach in a pregnancy-induced thrombocytopenia(PITP)patient,emphasizing rapid gastroscopy examination,histopathological confi rmation,multidisciplinary management,and high-risk factors for hospital-acquired gastrointestinal mucormycosis infection.
文摘This paper is focused on discussing the case of Las Loras UNESCO Global Geopark,in Spain,as an example to show the contribution of Geoparks to the dissemination of science and the relevance of preserving geoheritage by implementing simple measures based on communication and prevention.Natural and anthropic hazards derived from climate change are endangering heritage and the well-ness of the society.Geoheritage is vulnerable.Nowadays we are witnessing the destruction of monuments with high emotional significance due to wars,but climate change is also contributing to the loss of the same cultural heritage.Prevention is often the best way to protect geoheritage from disappearing and society is the best agent to implement preventive measures.Citizens are often unaware of the important treasures they have around them.Geoparks have been a great tool to bring awareness in society,since by involving the public in the whole process of recognition and promotion,they protect the space and the cultural and economic values associated with them.It is important to communicate the initiatives taking place in the Geoparks to explain the importance of geology and the risk of losing the geoheritage if natural hazards increase.Las Loras study is a good practice to implement in other Geoparks.
基金supported by the National Key Research and Development Program of China(2021YFC2501800)Shanghai Committee of Science and Technology(20Y11900100,21MC1930400,and 20DZ2261200)Clinical Research Plan of Shanghai Hospital Development Center(SHDC2020CR4059)。
文摘BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis patients.In this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-associated coagulopathy(SAC)criteria in identifying overt-DIC and preDIC status in sepsis patients.METHODS:Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022.The performances of the SIC and SAC were assessed to identify overt-DIC on days 1,3,7,or 14.The SIC status or SIC score on day 1,the SAC status or SAC score on day 1,and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC.The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation.RESULTS:On day 1,the incidences of coagulopathy according to overt-DIC,SIC and SAC criteria were 11.7%,22.0%and 31.5%,respectively.The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14(P<0.05).On day 1,the SIC score with a cut-off value>3 had a significantly higher sensitivity(72.00%)and area under the curve(AUC)(0.69)in identifying pre-DIC than did the SIC or SAC status(sensitivity:SIC status 44.00%,SAC status 52.00%;AUC:SIC status 0.62,SAC status 0.61).The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC(0.79 vs.0.69,P<0.001).Favorable effects of anticoagulant therapy were observed in SIC(adjusted hazard ratio[HR]=0.216,95%confidence interval[95%CI]:0.060–0.783,P=0.018)and SAC(adjusted HR=0.146,95%CI:0.041–0.513,P=0.003).CONCLUSION:The SIC and SAC seem to be valuable for predicting overt-DIC.The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.
文摘Objective:To summarize the clinical characteristics and treatment plan for a case of disseminated nocardiosis.Methods:The study summarized the clinical characteristics and treatment plan for a case of disseminated nocardiosis.Results:The primary symptoms of the patient included high fever and multiple enlarged lymph nodes.Chest computed tomography revealed a shadow of nodules in the upper lobe of the left lung,multiple nodules,and pleural effusion in both lungs.Additionally,bilateral blood cultures indicated the presence of Nocardia terpenica.The final diagnosis was disseminated Nocardia sp.infection.Upon admission,anti-infective treatment was initiated with sulfamethoxazole and linezolid.Conclusion:In patients with normal immune function,disseminated nocardiosis may present as high fever with lymph node enlargement,necessitating differentiation from lymphoma.This study reports on the diagnosis and treatment plan of a case of disseminated nocardiosis to enhance understanding and clinical management of this disease.
基金Funded by the Health Science and Technology Program of Inner Mongolia Autonomous Region(no.202201061)Supported by the Joint Project of theMillion Science and Technology Initiatives of Inner Mongolia Medical University(no.YKD2020KJBW(LH)057).
文摘Objective:Lung adenocarcinoma exhibits diverse genetic and morphological backgrounds,in addition to considerable differences in clinical pathology and molecular biological characteristics.Among these,the phenomenon of spread through air space(STAS),a distinct mode of lung cancer infiltration,has rarely been reported.Therefore,this study aimed to explore the relationship between STAS tumor cells and the clinical and molecular characteristics of patients with lung adenocarcinoma,as well as their impact on prognosis.Methods:This study included 147 patients who were diagnosed with lung adenocarcinoma at the Inner Mongolia Autonomous Region Cancer Institute between January 2014 and December 2017.Surgical resection specimens were retrospectively analyzed.Using univariate and multivariate Cox analyses,we assessed the association between STAS and the clinicopathological features and molecular characteristics of patients with lung adenocarcinoma.Furthermore,we investigated the effects on patient prognosis.In addition,we developed a column–line plot prediction model and performed internal validation.Results:Patients with positive STAS had a significantly higher proportion of tumors with a diameter≥2 cm,with infiltration around the pleura,blood vessels,and nerves,and a pathological stage>IIB than in STAS-negative patients(P<0.05).Cox multivariate survival analysis revealed that clinical stage,STAS status,tumor size,and visceral pleural invasion were independent prognostic factors influencing the 5-year progression-free survival in patients with lung adenocarcinoma.The predictive values and P values from the Hosmer-Lemeshow test were 0.8 and 0.2,respectively,indicating no statistical difference.Receiver operating characteristic curve analysis demonstrated areas under the curve of 0.884 and 0.872 for the training and validation groups,respectively.The nomogram model exhibited the best fit with a value of 192.09.Conclusions:Clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis are independent prognostic factors for patients with STAS-positive lung adenocarcinoma.The nomogrambased on the clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis showed good accuracy,differentiation,and clinical practicality.
基金the National Natural Science Foundation of China,No. 81000518 and 30770824China Postdoc-toral Science Foundation,No. 201003237+2 种基金the Scien-tific Research Foundation for the Returned Overseas Chinese Scholars,Ministry of Education of ChinaShang-hai Pujiang Program,No. 09PJ1408300the Science and Technology Commission of Shanghai Municipality Project,No. 10JC1402300.
文摘Coagulation abnormalities, such as disseminated intravascular coagulation （DIC）, are associated with progressive hemcrrhagic injury （PHI） following head trauma. However, the exact relationship between coagulopathy and PHI remains unclear. The present study utilized a scoring system defined by the International Society of Thrombosis and Haemostasis to investigate whether a high DIC score is predictive for PHI. This study was a multicenter prospective design involving four hospitals, a 6-month observation, and follow-up. Of 352 traumatic brain injury （TBI） patients, serial CT scan indicated approximately one third of patients developed progressive hemorrhage, which was most frequently observed in the frontal, temporal, and orbitofrontal lobes of patients with brain contusion. PHI-positive patients exhibited poor prognosis, as indicated by prolonged length of hospital/intensive care unit stay and high mortality. More importantly, a DIC score after TBI, as well as patient age and sex, could serve as predictors for PHI. In addition, DIC scores were closely associated with injury severity. Therefore, the DIC scoring system facilitated early PHI diagnosis in TBI patients, and DIC scores might serve as a valuable predictor for TBI patients with PHI.
文摘Disseminated carcinomatosis of the bone marrow is characterized by widespread bone metastasis(bone marrow infiltration) from solid tumors with hematological disorders coexisted. This disease is frequently complicated with gastric cancer among solid tumors although its incidence is very rare. In recent years,technological innovations in diagnosis and treatment for cancer have remarkably improved,which made survival rates of various cancers prolonged. Prognosis of disseminated carcinomatosis of the bone marrow associated with gastric cancer,however,is still poor(less than a year),possibly because this disease has not been given attention due to low incidence. In this review,I summarize the results obtained for the past,and propose ways to improve the prognosis of this disease.
基金funded by grants from the Science and Technology Planning Project of Guangdong Province(2014A020211022)Science and Technology Planning Project of Guangzhou Province(201510010074)
文摘Objective:To investigate whether atractylenolide Ⅰ(ATL-Ⅰ) has protective effect on lipopolysaccharide(LPS)-induced disseminated intravascular coagulation(DIC) in vivo and in vitro,and explore whether NF-κB signaling pathway is involved in ATL-Ⅰ treatment.Methods:New Zealand white rabbits were injected with LPS through marginal ear vein over a period of 6h at a rate of 600 μg/kg(10 mL/h).Similarly,in the treatment groups,1.0,2.0,or 5.0 mg/kg ATL-Ⅰ were given.Both survival rate and organ function were tested,including the level of alanine aminotransferase(ALT),blood urine nitrogen(BUN),and TNF-α were examined by ELISA.Also haemostatic and fibrinolytic parameters in serum were measured.RAW 264.7 macrophage cells were administered with control,LPS,LPS + ATL-Ⅰ and ATL-Ⅰ alone,and TNF-α,phosphorylation(P)-IκBα,phosphorylation(P)-NF-κB(P65) and NF-κB(P65) were determined by Western blot.Results:The administration of LPS resulted in 73.3%mortality rate,and the increase of serum TNF-α,BUN and ALT levels.When ATL-Ⅰ treatment significantly increased the survival rate of LPS-induced DIC model,also improved the function of blood coagulation.And protein analysis indicated that ATL-Ⅰ remarkably protected liver and renal as decreasing TNF-α expression.In vitro,ATL-Ⅰ obviously decreased LPS-induced TNF-αproduction and the expression of P-NF-κB(P65),with the decrease of P-IκBα.Conclusions:ATL-Ⅰ has protective effect on LPS-induced DIC,which can elevate the survival rate,reduce organ damage,improve the function of blood coagulation and suppress TNF-α expression by inhibiting the activation of NF-κB signaling pathway.
文摘In this study,we used plasma factor V activity and parameters of the thrombin generation test to discuss their diagnostic and prognostic value for disseminated intravascular coagulation (DIC) in patients with hematological malignancies.A total of 164 patients who were diagnosed with hematological malignancies in the Department of Hematology,Union Hospital,between Apr 2014 and Dec.2014 were enrolled in this study.There were 131 patients in the study group and 33 patients in the control group in terms of the laboratory results for DIC.The patients in the study group were divided into a DIC subgroup (n=59) and a non-DIC subgroup (n=72) based on the International Society of Thrombosis and Hemostasis (ISTH) Integral System,and they were divided into four subgroups [score ≤3 (n=35),score=4 (n=37),score=5 (n=47),and score >6 (n=12)] according to ISTH scores.Using 28-day mortality as the endpoint,the patients in the study group were divided into a survival subgroup (n=111) and a non-survival subgroup (n=20).The results showed that the plasma factor V activity was significantly weaker,and lag time and time to peak were significantly shorter in the study group than in the control group (P<0.01).The factor V activity,peak and endogenous thrombin potential (ETP) were significantly decreased in the DIC subgroup as compared with those in the non-DIC subgroup (P<0.01).Among factor V activity,lag time,peak,ETP,and ttPeak,only the factor V activity was significantly decreased in the nonsurvival subgroup compared with the survival subgroup (P<0.01).With the increase in ISTH score,the ETP and peak decreased gradually.The binary logistic regression analysis revealed that PLT,D-dimer,factor V activity and ETP had linear relationship with DIC diagnosed by ISTH Integral System.Using DIC diagnosed by ISTH Integral System as the endpoint,the area under curve (AUC) of factor V activity was found to be similar to that of blood platelet count (PLT) and prothrombin time (PT).In conclusion,factor V activity,ETP and peak had diagnostic value for DIC in patients with hematological malignancies,and only factor V activity had limited prognostic value.
基金jointly supported by the National Key Research and Development Project of China (Grant No.2016YFC0600307)the National Key Basic Research Development Program (973 Program+1 种基金 Grant No.2015CB452606)the fundamental research funds of university teachers(No.53200959708 and No.2-9-2018-126)
文摘Orogenic disseminated and Carlin gold deposits share much similarity in alteration and mineralization.The disseminated orogenic Zhenyuan Au deposit along the Ailaoshan shear zone,southeastern Tibet,was selected to clarify their difference.The alteration and mineralization from the different lithologies,including meta-quartz sandstone,carbonaceous slate,meta-(ultra)mafic rock,quartz porphyry and lamprophyre were researched.According to the mineral assemblage and replacement relationship in all types of host rocks,two reactions show general control on gold deposition:(1) replacement of earlier magnetite by pyrite and carbonaceous material;(2) alteration of biotite and phlogopite phenocrysts in quartz porphyry and lamprophyre into dolomite/ankerite and sericite.Despite the lamprophyre is volumetrically minor and much less fractured than other host rocks,it contains a large portion of Au reserve,indicating that the chemically active lithology has played a more important role in gold precipitation compared to structure.LA-ICP-MS analysis shows that Au mainly occurs as invisible gold in fine-grained pyrite disseminated in the host rocks,with Au content reaching to 258.95 ppm.The diagenetic core of pyrite in meta-quartz sandstone enriched in Co,Ni,Mo,Ag and Hg is wrapped by hydrothermal pyrite enriched in Cu,As,Sb,Au,Tl,Pb and Bi.Different host rock lithology has much impact on the alteration and mineralization features.Carbonate and sericite in altered lamprophyre show they have higher Mg than those developed in other of host rocks denoting that the carbonate and sericite incorporated Mg from phlogopite phenocrysts in the primary lamprophyre during alteration.The ore fluid activated the diagenetic pyrite in meta-quartz sandstone leading the hydrothermal pyrite enriched in Cu,Mo,Ag,Sb,Te,Hg,Tl,Pb and Bi,but the hydrothermal pyrite in meta-(ultra)mafic rock is enriched in Co and Ni as the meta-(ultra)mafic rock host rock contain high content of Co and Ni.However,Au and As shear similar range in both types of host rocks indicating that these two elements most likely come from the deep source fluid rather than the host rocks.It was shown in the disseminated orogenic gold deposit that similar hydrothermal alteration with mineral assemblage of carbonate (mainly dolomite and ankerite),sericite,pyrite and arsenopyrite develops in all types of host rocks.This is different from the Nevada Carlin type,in which alteration is mainly dissolution and silicification of carbonate host rock.On the other hand,Au mainly occur as invisible gold in both disseminated orogenic and Carlin gold deposits.
基金the AUCC-CIDASULCP program,he Innovative Project of the ChineseAcademy of Sciences(KZCX3-sw-137) the"Tenth Five-year"National Key Science and Technology Project(2001BA690A-07-01).
文摘Sedimentary rock-hosted disseminated gold (SRHDG) deposits in the Youjiang-Nanpanjiang Basin, southwestern Guizhou Province are commonly hosted by the same fold crests that commonly contain a remarkable amount of organic material. The total organic carbon (TOC) contents of the ores and host rocks are usually less than 1%. The reflectance of vitrinite and pyrobitumen in the ores and the host rocks ranges from 1.5% to 4.5%, often in the range of 2% to 3%. In the Lannigou deposit, the reflectance of vitrinite and pyrobitumen in the ores is usually somewhat higher than those within the host rocks, indicating a hydrothermal impact on the organic matter in the altered host rocks. On the contrary, the estimated maximum paleotemperatures of the Getang and Zimudang deposits are higher than the homogenization temperatures of the fluid inclusions in the ores, signifying that the organic matter maturation predated Au mineralization. No correlation between the organic matter contents and Au concentrations were recognized in the ores. However, the most striking observation is that there is a positive correlation between the S2 (a parameter of Rock-Eval analysis), Au and As contents of the ores in the Lannigou deposit. Organic matter maturation and migration is apparent from the TOC vs. HCI diagram. Furthermore, group analysis of the dichloromethane extractable organic component of the ores and host rocks shows that the maturation degree of the organic matter in the ores is slightly higher than that of the host rocks in the Lannigou gold deposit. However, the compositions of their alkanes, steranes and terpenes, which serve as biomarkers, are quite similar; this suggests that the organic matter found in the ores and host rocks has a common marine source. Organic matter probably contributed to the preconcentration of Au in the host rocks. Hydrocarbons in the system, on the other hand, clearly contributed to the emplacement of the gold mineralization through thermal sulfate reduction. Organic matter in the solution might have increased the potential of the hydrothermal solution to transport Au.
文摘AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P < 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P < 0.01, OR = 12, 95%CI: 2.3-60). Although the difference did not reach statistical significance, primary diseases(malignancies)(P = 0.055, OR = 3.9, 95%CI: 0.97-16) and the non-use of r TM had a tendency to be associated with persistent DIC(P = 0.08, OR = 4.3, 95%CI: 0.84-22).CONCLUSION: The add-on effects of r TM are anticipated in the treatment of AC-induced DIC, although biliary drainage for AC remains crucial.
文摘BACKGROUND Visceral disseminated varicella-zoster virus(VZV)infection is a rare but lifethreatening disease.In transplant recipients with VZV infection,visceral dissemination may develop without skin eruptions,which leads to the failure of early diagnosis.CASE SUMMARY The patient was a 33-year-old male renal recipient who was referred to our hospital with severe upper abdominal pain of 3-d duration.On admission,the patient rapidly developed septic shock and multiple organ dysfunction syndrome with liver dysfunction and acute kidney injury.Next-generation sequencing of peripheral blood yielded 39224 sequence reads of VZV,and real-time polymerase chain reaction for VZV was positive,with 1.2×10^(7) copies/mL.The final diagnosis was visceral disseminated VZV infection.Acyclovir and supportive therapy were started,but the patient died of severe visceral organ damage 16 h after admission.CONCLUSION Visceral disseminated VZV infection is possible in renal transplant recipients presenting abdominal pain and rapidly-evolving organ damage without skin involvement.
文摘Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts.Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for two days.Diagnosis: Disseminated nocardiosis due to Nocardia otitidiscaviarum. Interventions: Initial antimicrobial therapy with imipenem and trimethoprim/sulfamethoxazole was switched to 6 weeks of trimethoprim/sulfamethoxazole, linezolid and tigecycline after sensitivity test results were available. Thereafter, the patient was switched to maintenance trimethoprim/sulfamethoxazole and moxifloxacin. Prednisolone was gradually tapered.Outcomes: Soft tissue swelling and pain disappeared and the patient was discharged uneventfully.Lessons: Disseminated nocardiosis due to Nocardia otitidiscaviarum should be suspected in immunocompetent hosts with risk factors such as medication with prednisolone. Early identification of the causative species and susceptibility results is crucial given the diverse resistance patterns amongst various Nocardia species.
基金supported by Hainan Provincial Natural Seience Foundation of China(818MS140)
文摘Objective: To explore the therapeutic effect and mechanism of myricctin on disseminated intravascular coagulation(DIC). Methods: The DIC model was established by injection of60 mg/kg LPS in KM mice, and the treatment groups were injected myricetin with different concentrations(25 or 50 mg/kg) 30 min before the model was established. Both coagulation indicators and organ function were tested, including PT, APTT, fibrinogen. AST, ALT. BUN and tissue section. In vitro, the inflammatory model of RAW 264.7 macrophage cells were established by 10 μg/mL LPS. The treatment group was treated with 50 μmol/mL myricetin for 30 min before LPS, and the expression of TNF-a and p-NF-KB was detected, further to explore the therapeutic mechanism. Results: LPS-induced DIC led to a reduction of fibrinogen and a rise of PT, APTT,AST, ALT, BUN levels, but the treatment of myricctin significantly inhibited these abnormalities. Histopathology analysis also revealed that myricetin remarkably protected the liver and renal damage. In vitro, the expression of TNF-α and p-NF-κB induced by LPS was repressed by myricetin. Conclusions: This study provides new insights into the protective effects of myricetin in LPS-induced DIC by anticoagulant and anti-inflammatory via suppressing the activation of p-NF-κB which decreased TNF-α level.
文摘The symptoms of disseminated strongyloidiasis are not typical,and it is difficult for clinicians to identify strongyloidiasis in some non-endemic areas.We report a 70-year-old woman who was diagnosed with Guillain-Barrésyndrome due to autonomic disturbance,symmetrical bulbar palsy,and lower-motor-nerve damage in the extremities;her symptoms continued to worsen after hormone and immunoglobulin therapy.Later,parasitic larvae were found in the patient’s gastric fluid,and metagenomic next generation sequencing(mNGS)detection of bronchoalveolar-lavage fluid also found a large number of Strongyloides roundworms.The patient was diagnosed with disseminated strongyloidiasis.The patient was given albendazole for anthelmintic treatment,but died two days after being transferred to the intensive care unit due to the excessive strongyloidiasis burden.In recent years,mNGS has been increasingly used in clinical practice,and is becoming the main means of detecting strongyloides stercoralis in non-endemic areas.Especially during the corona virus disease 2019 pandemic,mNGS technology has irreplaceable value in identifying the source of infection.
基金supported by the fund of "Clinical Study on Traditional Chinese Medicine for Severe A (H1N1) Influenza Cases 200907001-2A"
文摘INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.
