BACKGROUND Immune-mediated necrotizing myopathy is a rare autoimmune myopathy characterized by muscle weakness and elevated serum creatine kinase,with unique skeletal muscle pathology and magnetic resonance imaging fe...BACKGROUND Immune-mediated necrotizing myopathy is a rare autoimmune myopathy characterized by muscle weakness and elevated serum creatine kinase,with unique skeletal muscle pathology and magnetic resonance imaging features.CASE SUMMARY In this paper,two patients are reported:One was positive for anti-signal recognition particle antibody,and the other was positive for anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibody.CONCLUSION The clinical characteristics and treatment of the two patients were analysed,and the literature was reviewed to improve the recognition,diagnosis,and treatment of this disease.展开更多
To the Editor:Hemolysis,which is caused by a variety of immune and non-immune mechanisms,is a well-recognized complication of solid organ transplantation.;Hemolysis post-liver transplantation can be induced by drug,in...To the Editor:Hemolysis,which is caused by a variety of immune and non-immune mechanisms,is a well-recognized complication of solid organ transplantation.;Hemolysis post-liver transplantation can be induced by drug,infection,autoimmune disorders,blood-group incompatible展开更多
[Objectives]To study the effect of total flavonoids extracted from Polygonum perfoliatum L.(TFP)on immune-mediated liver injury induced by bacillus Calmette-Guerin plus lipopolysaccharide(BCG+LPS)in mice,and to explor...[Objectives]To study the effect of total flavonoids extracted from Polygonum perfoliatum L.(TFP)on immune-mediated liver injury induced by bacillus Calmette-Guerin plus lipopolysaccharide(BCG+LPS)in mice,and to explore its action mechanism.[Methods]60 Kunming mice were divided into normal group,model group,control group(bifendate)and TFP low,medium and high dose groups according to random number table method,with 10 mice in each group.On the first day of modeling,mice were injected with 0.2 mL of BCG solution(12.5 mg/mL)through the tail vein,and on the eleventh day,0.2 mL of LPS(37.5μg/mL)were injected into the tail vein to prepare a mouse model of immune-mediated liver injury;from the first day of modeling,the normal group and the model group were administered intragastrically with the corresponding volume of distilled water,and the bifendate group and the TFP high,medium,and low dose groups were administered intragastrically with the corresponding doses once a day for 11 d.After the last time administration,fasting but giving water for 16 h,took blood from eyes,then collected the liver tissue.The levels of alanine transaminase(ALT)and aspartate transaminase(AST)in serum were detected by biochemical method;transforming growth factor-β1(TGF-β1),intercellular adhesion molecule-1(ICAM-1),interleukin-6(IL-6)and interleukin-1β(IL-1β)expression levels in liver tissue were detected by enzyme-linked immunosorbent assay(ELISA);phosphorylated protein tyrosine kinase JAK-2(p-JAK2),phosphorylated signal transducer and activator of transcription 3(p-STAT3)protein expression levels were detected by Western Blot method;the degree of liver tissue lesions was detected by HE staining.[Results]Compared with the model group,the levels of ALT and AST in the serum of mice in each dose group of TFP(high dose 600 mg/kg,medium dose 400 mg/kg,and low dose 200 mg/kg)were reduced,and the activities of T-SOD and GSH-Px were increased;the content or expression ofβ1,ICAM-1,IL-6,IL-1βdecreased,and the expression of p-JAK2 and p-STAT3 protein decreased;pathological sections showed that the degree of inflammatory necrosis and the degree of lesions in the liver tissues of each dose group of TFP were reduced by varying degrees.[Conclusions]TFP has a protective effect on BCG+LPS-induced immune-mediated liver injury in mice.The mechanism may be related to regulating the phosphorylation level of JAK2 and inhibiting the inflammatory reaction,thereby regulating the TGF-β1/STAT3 signaling pathway and improving the immune-mediated liver injury.展开更多
Immune-mediated hepatitis(IMH)induced by immune checkpoint inhibitors(ICIs)is an immune-related adverse event(irAE).IMH usually occurs 8-12 weeks after the first dose of ICI therapy.We report an unusual case of a lung...Immune-mediated hepatitis(IMH)induced by immune checkpoint inhibitors(ICIs)is an immune-related adverse event(irAE).IMH usually occurs 8-12 weeks after the first dose of ICI therapy.We report an unusual case of a lung cancer patient who developed IMH 2 years after initial ICI treatment and relapsed during corticosteroid therapy.A 55-year-old male with stageⅣB lung cancer received ICIs(for over 2 years)and chemotherapy as a second-line therapy.Grade 4 IMH occurred 2 years after initial immunotherapy and was diagnosed as hepatitis via laboratory and imaging tests with the simultaneous exclusion of other causes.The patient responded well to the corticosteroids;however,he decided to discontinue treatment prematurely,meaning that the total treatment period was less than 4 weeks.This led to IMH reoccurrence and the need to readminister corticosteroids at a higher dose than before.Ultimately,the patient's IMH was controlled and did not reoccur.This case illustrates that immune-related toxicity needs to be monitored in patients undergoing long-term ICI therapy.Improving patient education is also essential for the management and treatment of irAEs.展开更多
Background:Clinically,it is difficult to differentiate multiple acyl-CoA dehydrogenase deficiency(MADD)from immune-mediated necrotizing myopathy(IMNM)because they display similar symptoms.This study aimed to determine...Background:Clinically,it is difficult to differentiate multiple acyl-CoA dehydrogenase deficiency(MADD)from immune-mediated necrotizing myopathy(IMNM)because they display similar symptoms.This study aimed to determine whether muscle magnetic resonance imaging(MRI)could be used for differential diagnosis between MADD and IMNM.Methods:The study evaluated 25 MADD patients,confirmed by muscle biopsy and ETFDH gene testing,and 30 IMNM patients,confirmed by muscle biopsy.Muscles were assessed for edema and fatty replacement using thigh MRI(tMRI).Degrees and distribution patterns of fatty infiltration and edema in gluteus maximus and thigh muscles were compared.Results:Total fatty infiltration and edema scores(median,[Q 1,Q3])were 4.00(1.00,15.00)and 0(0,4.00)in MADD and 14.50(8.00,20.75)and 22.00(16.75,32.00)in IMNM,respectively,which were significantly more severe in IMNM than that in MADD(P=0.000 and P=0.004~respectively).Edema scores tbr gluteus maximus,long head of biceps femoris,and semimembranosus were significantly higher in IMNM than in MADD(all P=0.000).Fatty infiltration scores for anterior and medial compartments were significantly more severe in IMNM than that in MADD(all P=0.000).Conclusion:Different patterns of muscle involvement on tMRI can contribute to differential diagnosis between MADD and IMNM when clinical suspicions alone are insufficient,thereby reducing the need for muscle biopsy.展开更多
Immune-mediated,drug-induced hepatitis is a rare complication of halogenated volatile anesthetic administration.IL-4-regulated Th2-polarized reactions initiate this type and other types of hepatitis,while the mechanis...Immune-mediated,drug-induced hepatitis is a rare complication of halogenated volatile anesthetic administration.IL-4-regulated Th2-polarized reactions initiate this type and other types of hepatitis,while the mechanisms that regulate the severity remain elusive.IL-33 is an innate,IL-4-inducing,Th2-polarizing cytokine that has been detected in patients with liver failure and has been associated with upregulated ST2+Foxp3+CD4+CD25+T cells;however,roles for IL-33 in drug-induced hepatitis are unclear.We investigated IL-33 in an anesthetic,immune-mediated hepatitis modeled in BALB/c,IL-33−/−and ST2−/−mice,as well as in patients with anesthetic hepatitis.The hepatic IL-33 and ST2 levels were elevated in BALB/c mice(p<0.05)with hepatitis,and anti-IL-33 diminished hepatitis(p<0.05)without reducing IL-33 levels.The complete absence of IL-33 reduced IL-10(p<0.05)and ST2+Foxp3+CD4+CD25+T cells(p<0.05),as well as reduced the overall survival(p<0.05),suggesting suppressive roles for IL-33 in anesthetic,immune-mediated hepatitis.All of the mice demonstrated similar levels of CD4+T-cell proliferation following direct Tcell receptor stimulation,but we detected splenic IL-33 and ST2-negative Foxp3+CD4+CD25+T cells in ST2−/−mice that developed less hepatitis than BALB/c mice(p<0.05),suggesting that ST2-negative Foxp3+CD4+CD25+T cells reduced hepatitis.In patients,serum IL-33 and IPEX levels were correlated in controls(r2=0.5,p<0.05),similar to the levels in mice,but not in anesthetic hepatitis patients(r2=0.01),who had elevated IL-33(p<0.001)and decreased IPEX(p<0.01).Our results suggest that,in anesthetic,immune-mediated hepatitis,IL-33 does not regulate the CD4+T-cell proliferation that initiates hepatitis,but IL-33,likely independent of ST2,reduces hepatitis via upregulation of Foxp3+CD4+CD25+T cells.Further studies are needed to translate the role of IL-33 to human liver disease.展开更多
Immune-mediated inflammatory diseases(IMIDs)represent a diverse group of diseases and challenges remain for the current medications.Herein,we present an activatable and targeted nanosystem for detecting and imaging IM...Immune-mediated inflammatory diseases(IMIDs)represent a diverse group of diseases and challenges remain for the current medications.Herein,we present an activatable and targeted nanosystem for detecting and imaging IMIDs foci and treating them through blocking NF-κB/NLRP3 pathways.A ROS-activatable prodrug BH-EGCG is synthesized by coupling a near-infrared chromophore with the NF-κB/NLRP3 inhibitor epigallocatechin-3-gallate(EGCG)through boronate bond which serves as both the fluorescence quencher and ROS-responsive moiety.BH-EGCG molecules readily form stable nanoparticles in aqueous medium,which are then coated with macrophage membrane to ensure the actively-targeting capability toward inflammation sites.Additionally,an antioxidant precursor N-acetylcysteine is co-encapsulated into the coated nanoparticles to afford the nanosystem BH-EGCG&NAC@MM to further improve the anti-inflammatory efficacy.Benefiting from the inflammation-homing effect of the macrophage membrane,the nanosystem delivers payloads(diagnostic probe and therapeutic drugs)to inflammatory lesions more efficiently and releases a chromophore and two drugs upon being triggered by the overexpressed in-situ ROS,thus exhibiting better theranostic performance in the autoimmune hepatitis and hind paw edema mouse models,including more salient imaging signals and better therapeutic efficacy via inhibiting NF-κB pathway and suppressing NLRP3 inflammasome activation.This work may provide perceptions for designing other actively-targeting theranostic nanosystems for various inflammatory diseases.展开更多
Background and Aims:Immune-mediated liver injury is a fatal side effect of sintilimab.This study aimed to shed light on the associated risk factors and characteristics of this adverse event.Methods:The clinical record...Background and Aims:Immune-mediated liver injury is a fatal side effect of sintilimab.This study aimed to shed light on the associated risk factors and characteristics of this adverse event.Methods:The clinical records of 772 patients treated with sintilimab were retrospectively reviewed to investigate risk factors associated with sintilimab immune-related hepatotoxicity,as well as its incidence and outcome.The Roussel Uclaf Causality Assessment Method was used o identify cases of sintilimab-induced hepatotoxicity.Furthermore,logistic regressions were performed to compare the clinical and bloodwork characteristics of patients with and without immune-mediated liver injury caused by checkpoint inhibitors.Resu/ts:Of the 585 patients included in the study,71(12.1%)developed liver injury during sintili-mab use.The median RUCAM score with interquartile range was 7(6,8).Hypoproteinemia,dyslipidemia,and the pres-ence of thyroid peroxidase antibodies were risk factors for sintilimab-related hepatotoxicity.A nomogram model was constructed for sintilimab-induced immune-mediated liver injury based on these risk factors,which had a C-index value of 0.713 and a good calibration curve.When applied o patients with grade≥3 and≥4 sintilimab-induced immune-mediated liver injury,it achieved C-index values of 0.752 and 0.811,respectively.The nomogram model also showed a good prediction potential in patients≥65 years and males.Six of the patients with sintilimab-related hepatotoxicity showed improved liver function upon treatment with steroids.Conclusions:This study demonstrated that hypoproteinemia,dyslipidemia,and the presence of thyroid peroxidase antibodies were clinically feasible prognostic biomarkers to predict liver injury in patients treated with sintilimab.展开更多
Introduction:Statin-associated immune-mediated necrotizing myositis(IMNM)is a rare but distinct idiopathic inflammatory myopathy(IIM)that requires early recognition and intervention to prevent irreversible muscle dama...Introduction:Statin-associated immune-mediated necrotizing myositis(IMNM)is a rare but distinct idiopathic inflammatory myopathy(IIM)that requires early recognition and intervention to prevent irreversible muscle damage.It is typically characterized by active statin use,elevated creatinine kinase(CK)levels,proximal muscle weakness,and at times,a positive 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase(HMGCR)antibody.Treatment includes immediate discontinuation of the statin and may include corticosteroids,intravenous immunoglobulin(IVIG),and/or immunosuppressive therapy.Inclusion body myositis(IBM),another distinct IIM,also presents with elevated CK levels but with insidious onset of distal upper and proximal lower extremity weakness and is typically refractory to treatment.Case Description:A 64-year-old female patient presented with proximal muscle weakness,elevated CK levels,and a positive HMGCR antibody in the setting of statin use with muscle pathology suggestive of both statinassociated IMNM and IBM.She responded to subcutaneous methotrexate and a slow prednisone taper over several months,however,will require close monitoring for symptoms associated with either disease.Conclusion:In conclusion,we report a case of muscle weakness with muscle pathology demonstrating both statin-associated IMNM and IBM.This case highlights the importance of understanding the clinical and pathological features of statin-associated IMNM and IBM.展开更多
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
Immune-mediated inflammatory diseases(IMIDs)represent a heterogeneous group of disorders driven by immune dysregulation,involving multiple organ systems and characterized by substantial clinical diversity.Traditional ...Immune-mediated inflammatory diseases(IMIDs)represent a heterogeneous group of disorders driven by immune dysregulation,involving multiple organ systems and characterized by substantial clinical diversity.Traditional classification based on affected organs fails to capture shared pathogenic mechanisms and impedes the development of unified therapeutic strategies.In recent years,reclassification of IMIDs according to the dominance of key cytokine hubs has emerged as a focus of research.Interleukin-1(IL-1),crucial in triggering and maintaining innate immune reactions,is key to the onset and continuation of inflammation.Aberrant activation of the IL-1 axis serves as a pathogenic driver in several prototypical auto-inflammatory diseases(AIDs)and plays a role in the development of inflammatory diseases like gout,hidradenitis suppurativa,recurrent pericarditis,and chronic recurrent multifocal osteomyelitis(CRMO),demonstrating a high degree of mechanistic convergence.Therapeutic strategies targeting IL-1 have shown favorable efficacy and safety in multiple clinical studies,with several agents approved for corresponding indications.As molecular mechanisms are further elucidated and biologic therapies continue to evolve,the IL-1 axis is increasingly recognized as a common inflammatory nexus within IMIDs.The reclassification framework centered on IL-1 provides a conceptual basis for the implementation of shared-treatment strategies across distinct diseases and establishes a theoretical and practical foundation for precision-targeted interventions.展开更多
Immune checkpoint inhibitors(ICIs) are monoclonal antibodies that target downregulators of the anti-cancer immune response: Cytotoxic T-lymphocyte antigen-4, programmed cell death protein-1, and its ligand programmed ...Immune checkpoint inhibitors(ICIs) are monoclonal antibodies that target downregulators of the anti-cancer immune response: Cytotoxic T-lymphocyte antigen-4, programmed cell death protein-1, and its ligand programmed death-ligand 1.ICIs have revolutionized the treatment of a variety of malignancies. However,many immune-related adverse events have also been described which mainly occurs as the immune system becomes less suppressed, affecting various organs including the gastrointestinal tract and causing diarrhea and colitis. The incidence of immune-mediated colitis(IMC) ranges from 1%-25% depending on the type of ICI and if used in combination. Endoscopically and histologically there is a significant overlap between IMC and inflammatory bowel disease,however more neutrophilic inflammation without chronic inflammation is usually present in IMC. Corticosteroids are recommended for grade 2 or more severe colitis while holding the immunotherapy. About one third to two thirds of patients are steroid refractory and benefit from infliximab. Recently vedolizumab has been found to be efficacious in steroid and infliximab refractory cases. While in grade 4 colitis, the immunotherapy is permanently discontinued, the decision is controversial in grade 3 colitis.展开更多
The gastrointestinal tract is frequently challenged by pathogens/antigens contained in food and water and the intestinal epithelium must be capable of rapid regeneration in the event of tissue damage. Disruption of th...The gastrointestinal tract is frequently challenged by pathogens/antigens contained in food and water and the intestinal epithelium must be capable of rapid regeneration in the event of tissue damage. Disruption of the intestinal barrier leads to a number of immune-mediated diseases, including inflammatory bowel disease, food allergy, and celiac disease. The intestinal mucosa is composed of different types of epithelial cells in specific barrier functions. Epithelial cells control surfaceassociated bacterial populations without disrupting the intestinal microflora that is crucial for host health. They are also capable of modulating mucosal immune system, and are thus essential in maintaining homeostasis in the gut. Thus, the regulation of intestinal epithelial homeostasis is crucial for the maintenance of the structure of the mucosa and the defensive barrier functions. Recent studies have demonstrated that multiple molecular pathways are involved in the regulation of intestinal epithelial cell polarity. These include the Wnt, Notch, Hippo, transforming growth factor-β(TGF-β)/bone morphogenetic protein(BMP) and Hedgehog pathways, most of which were identified in lower organisms where they play important roles during embryogenesis. These pathways are also used in adult organisms to regulate multiple self-renewing organs. Understanding the interactions between these molecular mechanisms and intestinal barrier function will therefore provide important insight into the pathogenesis of intestinal-based immune-mediated diseases.展开更多
The treatment of patients with inflammatory bowel disease(IBD),especially those with severe or refractory disease,represents an important challenge for the clinical gastroenterologist.It seems to be no exaggeration to...The treatment of patients with inflammatory bowel disease(IBD),especially those with severe or refractory disease,represents an important challenge for the clinical gastroenterologist.It seems to be no exaggeration to say that in these patients,not only the scientific background of the gastroenterologist is tested,but also the abundance of“gifts”that he should possess(insight,intuition,determ-ination,ability to take initiative,etc.)for the successful outcome of the treatment.In daily clinical practice,depending on the severity of the attack,IBD is treated with one or a combination of two or more pharmaceutical agents.These combin-ations include not only the first-line drugs(e.g.,mesalazine,corticosteroids,antibiotics,etc)but also second-and third-line drugs(immunosuppressants and biologic agents).It is a fact that despite the significant therapeutic advances there is still a significant percentage of patients who do not satisfactorily respond to the treatment applied.Therefore,a part of these patients are going to surgery.In recent years,several small-size clinical studies,reviews,and case reports have been published combining not only biological agents with other drugs(e.g.,immunosuppressants or corticosteroids)but also the combination of two biologi-cal agents simultaneously,especially in severe cases.In our opinion,it is at least a strange(and largely unexplained)fact that we often use combinations of drugs in a given patient although studies comparing the simultaneous administration of two or more drugs with monotherapy are very few.As mentioned above,there is a timid tendency in the literature to combine two biological agents in severe cases unresponsive to the applied treatment or patients with severe extraintestinal manifestations.The appropriate dosage,the duration of the administration,the suitable timing for checking the clinical and laboratory outcome,as well as the treatment side-effects,should be the subject of intense clinical research shortly.In this editorial,we attempt to summarize the existing data regarding the already applied combination therapies and to humbly formulate thoughts and suggestions for the future application of the combination treatment of biological agents in a well-defined category of patients.We suggest that the application of biomarkers and artificial intelligence could help in establishing new forms of treatment using the available modern drugs in patients with IBD resistant to treatment.展开更多
Neuromuscular ultrasound(NMUS) is a rapidly evolving technique used in neuromuscular medicine to provide complimentary information to standard electrodiagnostic studies. NMUS provides a dynamic, real time assessment o...Neuromuscular ultrasound(NMUS) is a rapidly evolving technique used in neuromuscular medicine to provide complimentary information to standard electrodiagnostic studies. NMUS provides a dynamic, real time assessment of anatomy which can alter both diagnostic and management pathways in peripheral nerve disorders. This review describes the current and future techniques used in NMUS and details the applications and developments in the diagnosis and monitoring of compressive, hereditary, immune-mediated and axonal peripheral nerve disorders, and motor neuron diseases. Technological advances have allowed the increased utilisation of ultrasound for management of peripheral nerve disorders;however, several practical considerations need to be taken into account to facilitate the widespread uptake of this technique.展开更多
BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet tran...BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet transfusion increasing,ineffective platelet transfusion has become increasingly prominent.Generally speaking,platelet antibodies can be produced after repeated transfusion,thus rendering subsequent platelet transfusion ineffective.We report a case of first platelet transfusion refractoriness(PTR)in a patient with acute myelocytic leukemia(AML).Due to the rarity of such cases in clinical practice,there have been no relevant case reports so far.CASE SUMMARY A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d.Her diagnosis was acute myelocytic leukemia[M2 type Fms related receptor tyrosine kinase 3,Isocitrate Dehydrogenase 1,Nucleophosmin 1,Neuroblastoma RAS viral oncogene homolog(+)high-risk group].She was treated with"IA"(IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5)chemotherapy.When her condition improved,the patient was discharged from the hospital,instructed to take medicine as prescribed by the doctor after discharge,and returned to the hospital for further chemotherapy on time.CONCLUSION We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy,which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load.This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML.When platelet antibodies are produced,immunoglobulins can be used to block antibodies,thereby reducing platelet destruction.For patients with PTR,both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.展开更多
Aims: To explore the therapeutic effect of electroacupuncture (EA) for treatment of male immune infertility patients and to observe the effect of EA on antisperm antibody (AsAb) positive reaction. Methods: A total of ...Aims: To explore the therapeutic effect of electroacupuncture (EA) for treatment of male immune infertility patients and to observe the effect of EA on antisperm antibody (AsAb) positive reaction. Methods: A total of 100 male infertility AsAb positive patients were randomized into EA group (n=50, BL 15, BL 17, 18, 23, etc.) and medication group (n=50, oral administration of prednisone, 5 mg/time, t.i.d.). Serum and sperm AsAb were determined with enzyme immunoassay technique. Results: Following 4 months’ treatment, the cure rates and the total effective rates of EA and medication groups were 40.4% (20 cases/50 cases) and 92.0% (45/50), 10.0% (5/50) and 64.0% (32/50) respectively. The cure rate of EA group was significantly superior to that of medication group (P<0.01). But, no significant difference was found between two groups in the total effective rate (P>0.05). After treatment, AsAb positive rates of both groups particularly that of EA group decreased significantly compared with pre treatment of each group (P<0.05-0.01). Conclusion: EA treatment can work well in the treatment of some immune mediated male infertility patients and possesses a favorable regulation action on AsAb reaction.展开更多
BACKGROUND Patients with immune-mediated diseases,such as juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)are at increased risk of developing infections,due to disease-related immune dysfunction a...BACKGROUND Patients with immune-mediated diseases,such as juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)are at increased risk of developing infections,due to disease-related immune dysfunction and applying of immunosuppressive drugs.AIM To evaluate vaccine coverage in patients with IBD and JIA,and compare it with healthy children.METHODS In the cross-sectional study we included the data from a questionnaire survey of 190 Legal representatives of children with JIA(n=81),IBD(n=51),and healthy children(HC,n=58).An electronic online questionnaire was created for the survey.RESULTS There were female predominance in JIA patients and younger onset age.Parents of JIA had higher education levels.Employment level and family status were similar in the three studied groups.Patients with JIA and IBD had lower vaccine coverage,without parental rejection of vaccinations in IBD,compare to JIA and healthy controls.The main reason for incomplete vaccination was medical conditions in IBD and JIA.IBD patients had a lower rate of normal vaccine-associated reactions compared to JIA and HC.The encouraging role of physicians for vaccinations was the lowest in JIA patients.IBD patients had more possibilities to check antibodies before immune-suppressive therapy and had more supplementary vaccinations compared to JIA and HC.CONCLUSION JIA and IBD patients had lower vaccine coverage compared to HC.Physicians'encouragement of vaccination and the impossibility of discus about future vaccinations and their outcomes seemed the main factors for patients with immune-mediated diseases,influencing vaccine coverage.Further investigations are required to understand the reasons for incomplete vaccinations and improve vaccine coverage in both groups,especially in rheumatic disease patients.The approaches that stimulate vaccination in healthy children are not always optimal in children with immunemediated diseases.It is necessary to provide personalized vaccine-encouraging strategies for parents of chronically ill children with the following validation of these technics.展开更多
Breast milk is the best source of nutrition that provides the energy and nutrients needed for the ideal growth and development of newborns and infants. Besides, breast milk includes various bioactive compounds, which ...Breast milk is the best source of nutrition that provides the energy and nutrients needed for the ideal growth and development of newborns and infants. Besides, breast milk includes various bioactive compounds, which protects infants against infectious agents and antigens and contributes to immune maturation, organ development and microbial colonization. Breast milk is dynamic;the composition of the nutrients and the content of immunological active compounds may change in each stage of lactation. During the early stages of lactation, biological and immunological active compounds provide additional support to the development of the neonatal immune system. After these stages, the composition of breast milk continues to provide appropriate energy and nutrients according to the infant needs, in order to protect neonatal immune system and maintain the development and growth of infants. Immunological maturation during the fetal life and the first months of life is provided by immunoglobulins in breast milk, which are among the most important immune protective factors and transferred to infants through breastfeeding. Due to their biological characteristics, Secretory Immunoglobulin A (SIgA) antibodies are the most important antibodies in breast milk, which provide the first defense against the antigens in the intestines of infants. In addition to antibodies, enzymes, including active leukocytes, cytokines, oligosaccharides, lactoferrin, lysozyme and lactoperoxidase, as well as biological and immunological factors, such as hormones, growth factors, bioactive peptides, nucleotides and fatty acids are transferred to infants through breastfeeding. There is now a growing body of evidence suggesting that breastfeeding protects infants against many infections such as gastrointestinal system and respiratory tract infections, strengthens immune system and provides protective effects against allergic and autoimmune diseases in later life.展开更多
文摘BACKGROUND Immune-mediated necrotizing myopathy is a rare autoimmune myopathy characterized by muscle weakness and elevated serum creatine kinase,with unique skeletal muscle pathology and magnetic resonance imaging features.CASE SUMMARY In this paper,two patients are reported:One was positive for anti-signal recognition particle antibody,and the other was positive for anti-3-hydroxy-3-methylglutaryl coenzyme A reductase antibody.CONCLUSION The clinical characteristics and treatment of the two patients were analysed,and the literature was reviewed to improve the recognition,diagnosis,and treatment of this disease.
基金supported by a grant from the Natural Science Foundation of Hunan Province(2016JJ4105)
文摘To the Editor:Hemolysis,which is caused by a variety of immune and non-immune mechanisms,is a well-recognized complication of solid organ transplantation.;Hemolysis post-liver transplantation can be induced by drug,infection,autoimmune disorders,blood-group incompatible
基金Natural Science Foundation Project of Guangxi(2017GXNSFAA 198326)。
文摘[Objectives]To study the effect of total flavonoids extracted from Polygonum perfoliatum L.(TFP)on immune-mediated liver injury induced by bacillus Calmette-Guerin plus lipopolysaccharide(BCG+LPS)in mice,and to explore its action mechanism.[Methods]60 Kunming mice were divided into normal group,model group,control group(bifendate)and TFP low,medium and high dose groups according to random number table method,with 10 mice in each group.On the first day of modeling,mice were injected with 0.2 mL of BCG solution(12.5 mg/mL)through the tail vein,and on the eleventh day,0.2 mL of LPS(37.5μg/mL)were injected into the tail vein to prepare a mouse model of immune-mediated liver injury;from the first day of modeling,the normal group and the model group were administered intragastrically with the corresponding volume of distilled water,and the bifendate group and the TFP high,medium,and low dose groups were administered intragastrically with the corresponding doses once a day for 11 d.After the last time administration,fasting but giving water for 16 h,took blood from eyes,then collected the liver tissue.The levels of alanine transaminase(ALT)and aspartate transaminase(AST)in serum were detected by biochemical method;transforming growth factor-β1(TGF-β1),intercellular adhesion molecule-1(ICAM-1),interleukin-6(IL-6)and interleukin-1β(IL-1β)expression levels in liver tissue were detected by enzyme-linked immunosorbent assay(ELISA);phosphorylated protein tyrosine kinase JAK-2(p-JAK2),phosphorylated signal transducer and activator of transcription 3(p-STAT3)protein expression levels were detected by Western Blot method;the degree of liver tissue lesions was detected by HE staining.[Results]Compared with the model group,the levels of ALT and AST in the serum of mice in each dose group of TFP(high dose 600 mg/kg,medium dose 400 mg/kg,and low dose 200 mg/kg)were reduced,and the activities of T-SOD and GSH-Px were increased;the content or expression ofβ1,ICAM-1,IL-6,IL-1βdecreased,and the expression of p-JAK2 and p-STAT3 protein decreased;pathological sections showed that the degree of inflammatory necrosis and the degree of lesions in the liver tissues of each dose group of TFP were reduced by varying degrees.[Conclusions]TFP has a protective effect on BCG+LPS-induced immune-mediated liver injury in mice.The mechanism may be related to regulating the phosphorylation level of JAK2 and inhibiting the inflammatory reaction,thereby regulating the TGF-β1/STAT3 signaling pathway and improving the immune-mediated liver injury.
文摘Immune-mediated hepatitis(IMH)induced by immune checkpoint inhibitors(ICIs)is an immune-related adverse event(irAE).IMH usually occurs 8-12 weeks after the first dose of ICI therapy.We report an unusual case of a lung cancer patient who developed IMH 2 years after initial ICI treatment and relapsed during corticosteroid therapy.A 55-year-old male with stageⅣB lung cancer received ICIs(for over 2 years)and chemotherapy as a second-line therapy.Grade 4 IMH occurred 2 years after initial immunotherapy and was diagnosed as hepatitis via laboratory and imaging tests with the simultaneous exclusion of other causes.The patient responded well to the corticosteroids;however,he decided to discontinue treatment prematurely,meaning that the total treatment period was less than 4 weeks.This led to IMH reoccurrence and the need to readminister corticosteroids at a higher dose than before.Ultimately,the patient's IMH was controlled and did not reoccur.This case illustrates that immune-related toxicity needs to be monitored in patients undergoing long-term ICI therapy.Improving patient education is also essential for the management and treatment of irAEs.
文摘Background:Clinically,it is difficult to differentiate multiple acyl-CoA dehydrogenase deficiency(MADD)from immune-mediated necrotizing myopathy(IMNM)because they display similar symptoms.This study aimed to determine whether muscle magnetic resonance imaging(MRI)could be used for differential diagnosis between MADD and IMNM.Methods:The study evaluated 25 MADD patients,confirmed by muscle biopsy and ETFDH gene testing,and 30 IMNM patients,confirmed by muscle biopsy.Muscles were assessed for edema and fatty replacement using thigh MRI(tMRI).Degrees and distribution patterns of fatty infiltration and edema in gluteus maximus and thigh muscles were compared.Results:Total fatty infiltration and edema scores(median,[Q 1,Q3])were 4.00(1.00,15.00)and 0(0,4.00)in MADD and 14.50(8.00,20.75)and 22.00(16.75,32.00)in IMNM,respectively,which were significantly more severe in IMNM than that in MADD(P=0.000 and P=0.004~respectively).Edema scores tbr gluteus maximus,long head of biceps femoris,and semimembranosus were significantly higher in IMNM than in MADD(all P=0.000).Fatty infiltration scores for anterior and medial compartments were significantly more severe in IMNM than that in MADD(all P=0.000).Conclusion:Different patterns of muscle involvement on tMRI can contribute to differential diagnosis between MADD and IMNM when clinical suspicions alone are insufficient,thereby reducing the need for muscle biopsy.
基金supported,in part,by the American Autoimmune Related Disease Association and Mr.and Mrs.Joseph Scoby and the Gail I Zuckerman foundations.
文摘Immune-mediated,drug-induced hepatitis is a rare complication of halogenated volatile anesthetic administration.IL-4-regulated Th2-polarized reactions initiate this type and other types of hepatitis,while the mechanisms that regulate the severity remain elusive.IL-33 is an innate,IL-4-inducing,Th2-polarizing cytokine that has been detected in patients with liver failure and has been associated with upregulated ST2+Foxp3+CD4+CD25+T cells;however,roles for IL-33 in drug-induced hepatitis are unclear.We investigated IL-33 in an anesthetic,immune-mediated hepatitis modeled in BALB/c,IL-33−/−and ST2−/−mice,as well as in patients with anesthetic hepatitis.The hepatic IL-33 and ST2 levels were elevated in BALB/c mice(p<0.05)with hepatitis,and anti-IL-33 diminished hepatitis(p<0.05)without reducing IL-33 levels.The complete absence of IL-33 reduced IL-10(p<0.05)and ST2+Foxp3+CD4+CD25+T cells(p<0.05),as well as reduced the overall survival(p<0.05),suggesting suppressive roles for IL-33 in anesthetic,immune-mediated hepatitis.All of the mice demonstrated similar levels of CD4+T-cell proliferation following direct Tcell receptor stimulation,but we detected splenic IL-33 and ST2-negative Foxp3+CD4+CD25+T cells in ST2−/−mice that developed less hepatitis than BALB/c mice(p<0.05),suggesting that ST2-negative Foxp3+CD4+CD25+T cells reduced hepatitis.In patients,serum IL-33 and IPEX levels were correlated in controls(r2=0.5,p<0.05),similar to the levels in mice,but not in anesthetic hepatitis patients(r2=0.01),who had elevated IL-33(p<0.001)and decreased IPEX(p<0.01).Our results suggest that,in anesthetic,immune-mediated hepatitis,IL-33 does not regulate the CD4+T-cell proliferation that initiates hepatitis,but IL-33,likely independent of ST2,reduces hepatitis via upregulation of Foxp3+CD4+CD25+T cells.Further studies are needed to translate the role of IL-33 to human liver disease.
基金supported by the National Natural Science Foundation of China(21875069 and 51673066)the Fund of Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates(2019B030301003).
文摘Immune-mediated inflammatory diseases(IMIDs)represent a diverse group of diseases and challenges remain for the current medications.Herein,we present an activatable and targeted nanosystem for detecting and imaging IMIDs foci and treating them through blocking NF-κB/NLRP3 pathways.A ROS-activatable prodrug BH-EGCG is synthesized by coupling a near-infrared chromophore with the NF-κB/NLRP3 inhibitor epigallocatechin-3-gallate(EGCG)through boronate bond which serves as both the fluorescence quencher and ROS-responsive moiety.BH-EGCG molecules readily form stable nanoparticles in aqueous medium,which are then coated with macrophage membrane to ensure the actively-targeting capability toward inflammation sites.Additionally,an antioxidant precursor N-acetylcysteine is co-encapsulated into the coated nanoparticles to afford the nanosystem BH-EGCG&NAC@MM to further improve the anti-inflammatory efficacy.Benefiting from the inflammation-homing effect of the macrophage membrane,the nanosystem delivers payloads(diagnostic probe and therapeutic drugs)to inflammatory lesions more efficiently and releases a chromophore and two drugs upon being triggered by the overexpressed in-situ ROS,thus exhibiting better theranostic performance in the autoimmune hepatitis and hind paw edema mouse models,including more salient imaging signals and better therapeutic efficacy via inhibiting NF-κB pathway and suppressing NLRP3 inflammasome activation.This work may provide perceptions for designing other actively-targeting theranostic nanosystems for various inflammatory diseases.
基金supported by the Startup Fund for Scientific Research,Fujian Medical University(2020QH1346 and 2020QH1345)Fujian Provincial Health Technology Project(2021QNA018)+3 种基金Fuzhou Health Science and Technology Project(grant numbers 2022-S-wq1)the Natural Science Foundation of Fujian Province(2021J011304)Joint Funds for the Innovation of Science and Technology,Fujian Province(Grant number:2018Y9045)Key Project for Youth Academic Talents(2019-ZQN-39)from Health and Family Planning Commission of Fujian Province.
文摘Background and Aims:Immune-mediated liver injury is a fatal side effect of sintilimab.This study aimed to shed light on the associated risk factors and characteristics of this adverse event.Methods:The clinical records of 772 patients treated with sintilimab were retrospectively reviewed to investigate risk factors associated with sintilimab immune-related hepatotoxicity,as well as its incidence and outcome.The Roussel Uclaf Causality Assessment Method was used o identify cases of sintilimab-induced hepatotoxicity.Furthermore,logistic regressions were performed to compare the clinical and bloodwork characteristics of patients with and without immune-mediated liver injury caused by checkpoint inhibitors.Resu/ts:Of the 585 patients included in the study,71(12.1%)developed liver injury during sintili-mab use.The median RUCAM score with interquartile range was 7(6,8).Hypoproteinemia,dyslipidemia,and the pres-ence of thyroid peroxidase antibodies were risk factors for sintilimab-related hepatotoxicity.A nomogram model was constructed for sintilimab-induced immune-mediated liver injury based on these risk factors,which had a C-index value of 0.713 and a good calibration curve.When applied o patients with grade≥3 and≥4 sintilimab-induced immune-mediated liver injury,it achieved C-index values of 0.752 and 0.811,respectively.The nomogram model also showed a good prediction potential in patients≥65 years and males.Six of the patients with sintilimab-related hepatotoxicity showed improved liver function upon treatment with steroids.Conclusions:This study demonstrated that hypoproteinemia,dyslipidemia,and the presence of thyroid peroxidase antibodies were clinically feasible prognostic biomarkers to predict liver injury in patients treated with sintilimab.
文摘Introduction:Statin-associated immune-mediated necrotizing myositis(IMNM)is a rare but distinct idiopathic inflammatory myopathy(IIM)that requires early recognition and intervention to prevent irreversible muscle damage.It is typically characterized by active statin use,elevated creatinine kinase(CK)levels,proximal muscle weakness,and at times,a positive 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase(HMGCR)antibody.Treatment includes immediate discontinuation of the statin and may include corticosteroids,intravenous immunoglobulin(IVIG),and/or immunosuppressive therapy.Inclusion body myositis(IBM),another distinct IIM,also presents with elevated CK levels but with insidious onset of distal upper and proximal lower extremity weakness and is typically refractory to treatment.Case Description:A 64-year-old female patient presented with proximal muscle weakness,elevated CK levels,and a positive HMGCR antibody in the setting of statin use with muscle pathology suggestive of both statinassociated IMNM and IBM.She responded to subcutaneous methotrexate and a slow prednisone taper over several months,however,will require close monitoring for symptoms associated with either disease.Conclusion:In conclusion,we report a case of muscle weakness with muscle pathology demonstrating both statin-associated IMNM and IBM.This case highlights the importance of understanding the clinical and pathological features of statin-associated IMNM and IBM.
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Immune-mediated inflammatory diseases(IMIDs)represent a heterogeneous group of disorders driven by immune dysregulation,involving multiple organ systems and characterized by substantial clinical diversity.Traditional classification based on affected organs fails to capture shared pathogenic mechanisms and impedes the development of unified therapeutic strategies.In recent years,reclassification of IMIDs according to the dominance of key cytokine hubs has emerged as a focus of research.Interleukin-1(IL-1),crucial in triggering and maintaining innate immune reactions,is key to the onset and continuation of inflammation.Aberrant activation of the IL-1 axis serves as a pathogenic driver in several prototypical auto-inflammatory diseases(AIDs)and plays a role in the development of inflammatory diseases like gout,hidradenitis suppurativa,recurrent pericarditis,and chronic recurrent multifocal osteomyelitis(CRMO),demonstrating a high degree of mechanistic convergence.Therapeutic strategies targeting IL-1 have shown favorable efficacy and safety in multiple clinical studies,with several agents approved for corresponding indications.As molecular mechanisms are further elucidated and biologic therapies continue to evolve,the IL-1 axis is increasingly recognized as a common inflammatory nexus within IMIDs.The reclassification framework centered on IL-1 provides a conceptual basis for the implementation of shared-treatment strategies across distinct diseases and establishes a theoretical and practical foundation for precision-targeted interventions.
文摘Immune checkpoint inhibitors(ICIs) are monoclonal antibodies that target downregulators of the anti-cancer immune response: Cytotoxic T-lymphocyte antigen-4, programmed cell death protein-1, and its ligand programmed death-ligand 1.ICIs have revolutionized the treatment of a variety of malignancies. However,many immune-related adverse events have also been described which mainly occurs as the immune system becomes less suppressed, affecting various organs including the gastrointestinal tract and causing diarrhea and colitis. The incidence of immune-mediated colitis(IMC) ranges from 1%-25% depending on the type of ICI and if used in combination. Endoscopically and histologically there is a significant overlap between IMC and inflammatory bowel disease,however more neutrophilic inflammation without chronic inflammation is usually present in IMC. Corticosteroids are recommended for grade 2 or more severe colitis while holding the immunotherapy. About one third to two thirds of patients are steroid refractory and benefit from infliximab. Recently vedolizumab has been found to be efficacious in steroid and infliximab refractory cases. While in grade 4 colitis, the immunotherapy is permanently discontinued, the decision is controversial in grade 3 colitis.
文摘The gastrointestinal tract is frequently challenged by pathogens/antigens contained in food and water and the intestinal epithelium must be capable of rapid regeneration in the event of tissue damage. Disruption of the intestinal barrier leads to a number of immune-mediated diseases, including inflammatory bowel disease, food allergy, and celiac disease. The intestinal mucosa is composed of different types of epithelial cells in specific barrier functions. Epithelial cells control surfaceassociated bacterial populations without disrupting the intestinal microflora that is crucial for host health. They are also capable of modulating mucosal immune system, and are thus essential in maintaining homeostasis in the gut. Thus, the regulation of intestinal epithelial homeostasis is crucial for the maintenance of the structure of the mucosa and the defensive barrier functions. Recent studies have demonstrated that multiple molecular pathways are involved in the regulation of intestinal epithelial cell polarity. These include the Wnt, Notch, Hippo, transforming growth factor-β(TGF-β)/bone morphogenetic protein(BMP) and Hedgehog pathways, most of which were identified in lower organisms where they play important roles during embryogenesis. These pathways are also used in adult organisms to regulate multiple self-renewing organs. Understanding the interactions between these molecular mechanisms and intestinal barrier function will therefore provide important insight into the pathogenesis of intestinal-based immune-mediated diseases.
文摘The treatment of patients with inflammatory bowel disease(IBD),especially those with severe or refractory disease,represents an important challenge for the clinical gastroenterologist.It seems to be no exaggeration to say that in these patients,not only the scientific background of the gastroenterologist is tested,but also the abundance of“gifts”that he should possess(insight,intuition,determ-ination,ability to take initiative,etc.)for the successful outcome of the treatment.In daily clinical practice,depending on the severity of the attack,IBD is treated with one or a combination of two or more pharmaceutical agents.These combin-ations include not only the first-line drugs(e.g.,mesalazine,corticosteroids,antibiotics,etc)but also second-and third-line drugs(immunosuppressants and biologic agents).It is a fact that despite the significant therapeutic advances there is still a significant percentage of patients who do not satisfactorily respond to the treatment applied.Therefore,a part of these patients are going to surgery.In recent years,several small-size clinical studies,reviews,and case reports have been published combining not only biological agents with other drugs(e.g.,immunosuppressants or corticosteroids)but also the combination of two biologi-cal agents simultaneously,especially in severe cases.In our opinion,it is at least a strange(and largely unexplained)fact that we often use combinations of drugs in a given patient although studies comparing the simultaneous administration of two or more drugs with monotherapy are very few.As mentioned above,there is a timid tendency in the literature to combine two biological agents in severe cases unresponsive to the applied treatment or patients with severe extraintestinal manifestations.The appropriate dosage,the duration of the administration,the suitable timing for checking the clinical and laboratory outcome,as well as the treatment side-effects,should be the subject of intense clinical research shortly.In this editorial,we attempt to summarize the existing data regarding the already applied combination therapies and to humbly formulate thoughts and suggestions for the future application of the combination treatment of biological agents in a well-defined category of patients.We suggest that the application of biomarkers and artificial intelligence could help in establishing new forms of treatment using the available modern drugs in patients with IBD resistant to treatment.
文摘Neuromuscular ultrasound(NMUS) is a rapidly evolving technique used in neuromuscular medicine to provide complimentary information to standard electrodiagnostic studies. NMUS provides a dynamic, real time assessment of anatomy which can alter both diagnostic and management pathways in peripheral nerve disorders. This review describes the current and future techniques used in NMUS and details the applications and developments in the diagnosis and monitoring of compressive, hereditary, immune-mediated and axonal peripheral nerve disorders, and motor neuron diseases. Technological advances have allowed the increased utilisation of ultrasound for management of peripheral nerve disorders;however, several practical considerations need to be taken into account to facilitate the widespread uptake of this technique.
基金Supported by Innovation Platform and Talent Program of Hunan Province,No.2021SK4050.
文摘BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet transfusion increasing,ineffective platelet transfusion has become increasingly prominent.Generally speaking,platelet antibodies can be produced after repeated transfusion,thus rendering subsequent platelet transfusion ineffective.We report a case of first platelet transfusion refractoriness(PTR)in a patient with acute myelocytic leukemia(AML).Due to the rarity of such cases in clinical practice,there have been no relevant case reports so far.CASE SUMMARY A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d.Her diagnosis was acute myelocytic leukemia[M2 type Fms related receptor tyrosine kinase 3,Isocitrate Dehydrogenase 1,Nucleophosmin 1,Neuroblastoma RAS viral oncogene homolog(+)high-risk group].She was treated with"IA"(IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5)chemotherapy.When her condition improved,the patient was discharged from the hospital,instructed to take medicine as prescribed by the doctor after discharge,and returned to the hospital for further chemotherapy on time.CONCLUSION We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy,which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load.This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML.When platelet antibodies are produced,immunoglobulins can be used to block antibodies,thereby reducing platelet destruction.For patients with PTR,both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.
文摘Aims: To explore the therapeutic effect of electroacupuncture (EA) for treatment of male immune infertility patients and to observe the effect of EA on antisperm antibody (AsAb) positive reaction. Methods: A total of 100 male infertility AsAb positive patients were randomized into EA group (n=50, BL 15, BL 17, 18, 23, etc.) and medication group (n=50, oral administration of prednisone, 5 mg/time, t.i.d.). Serum and sperm AsAb were determined with enzyme immunoassay technique. Results: Following 4 months’ treatment, the cure rates and the total effective rates of EA and medication groups were 40.4% (20 cases/50 cases) and 92.0% (45/50), 10.0% (5/50) and 64.0% (32/50) respectively. The cure rate of EA group was significantly superior to that of medication group (P<0.01). But, no significant difference was found between two groups in the total effective rate (P>0.05). After treatment, AsAb positive rates of both groups particularly that of EA group decreased significantly compared with pre treatment of each group (P<0.05-0.01). Conclusion: EA treatment can work well in the treatment of some immune mediated male infertility patients and possesses a favorable regulation action on AsAb reaction.
文摘BACKGROUND Patients with immune-mediated diseases,such as juvenile idiopathic arthritis(JIA)and inflammatory bowel disease(IBD)are at increased risk of developing infections,due to disease-related immune dysfunction and applying of immunosuppressive drugs.AIM To evaluate vaccine coverage in patients with IBD and JIA,and compare it with healthy children.METHODS In the cross-sectional study we included the data from a questionnaire survey of 190 Legal representatives of children with JIA(n=81),IBD(n=51),and healthy children(HC,n=58).An electronic online questionnaire was created for the survey.RESULTS There were female predominance in JIA patients and younger onset age.Parents of JIA had higher education levels.Employment level and family status were similar in the three studied groups.Patients with JIA and IBD had lower vaccine coverage,without parental rejection of vaccinations in IBD,compare to JIA and healthy controls.The main reason for incomplete vaccination was medical conditions in IBD and JIA.IBD patients had a lower rate of normal vaccine-associated reactions compared to JIA and HC.The encouraging role of physicians for vaccinations was the lowest in JIA patients.IBD patients had more possibilities to check antibodies before immune-suppressive therapy and had more supplementary vaccinations compared to JIA and HC.CONCLUSION JIA and IBD patients had lower vaccine coverage compared to HC.Physicians'encouragement of vaccination and the impossibility of discus about future vaccinations and their outcomes seemed the main factors for patients with immune-mediated diseases,influencing vaccine coverage.Further investigations are required to understand the reasons for incomplete vaccinations and improve vaccine coverage in both groups,especially in rheumatic disease patients.The approaches that stimulate vaccination in healthy children are not always optimal in children with immunemediated diseases.It is necessary to provide personalized vaccine-encouraging strategies for parents of chronically ill children with the following validation of these technics.
文摘Breast milk is the best source of nutrition that provides the energy and nutrients needed for the ideal growth and development of newborns and infants. Besides, breast milk includes various bioactive compounds, which protects infants against infectious agents and antigens and contributes to immune maturation, organ development and microbial colonization. Breast milk is dynamic;the composition of the nutrients and the content of immunological active compounds may change in each stage of lactation. During the early stages of lactation, biological and immunological active compounds provide additional support to the development of the neonatal immune system. After these stages, the composition of breast milk continues to provide appropriate energy and nutrients according to the infant needs, in order to protect neonatal immune system and maintain the development and growth of infants. Immunological maturation during the fetal life and the first months of life is provided by immunoglobulins in breast milk, which are among the most important immune protective factors and transferred to infants through breastfeeding. Due to their biological characteristics, Secretory Immunoglobulin A (SIgA) antibodies are the most important antibodies in breast milk, which provide the first defense against the antigens in the intestines of infants. In addition to antibodies, enzymes, including active leukocytes, cytokines, oligosaccharides, lactoferrin, lysozyme and lactoperoxidase, as well as biological and immunological factors, such as hormones, growth factors, bioactive peptides, nucleotides and fatty acids are transferred to infants through breastfeeding. There is now a growing body of evidence suggesting that breastfeeding protects infants against many infections such as gastrointestinal system and respiratory tract infections, strengthens immune system and provides protective effects against allergic and autoimmune diseases in later life.
