ASIA and BIA-ALCL as adverse reactions to silicone breast implants / ASIA e BIA-ALCL como reações adversas aos implantes mamários de silicone

Adjuvant-induced autoimmune/inflammatory syndrome leads to capsular contracture and fibrosis from the oxidation that takes place in silicone. Anaplastic large cell lymphoma occurs through the development of a seroma, with the formation of a periprosthetic effusion, or through the infiltration of the condition itself. To analyze these conditions, a review of the literature was carried out on the symptoms and pathophysiology of the autoimmune/inflammatory syndrome induced by adjuvants and anaplastic large cell lymphoma, searched using the terms "ASIA breast silicone," "Lymphoma," "Adjuvants" "Immunologic" " Breast Implants" on the PubMed platform. Analyzing the data obtained, it was noted that the symptoms of the autoimmune/inflammatory syndrome induced by adjuvants are nonspecific, such as fatigue, myalgia, arthralgia, morning stiffness, and night sweats, and therefore need attention. Anaplastic large cell lymphoma presents with breast pain, periprosthetic effusion, and palpable mass, among other characteristics. Because of these aspects, it is concluded that a good investigation should be carried out when nonspecific symptoms appear, regardless of the time the surgery was performed since these complications can occur years later.

A síndrome autoimune/inflamatória induzida por adjuvantes leva à contratura capsular e fibrose pela oxidação que acontece no silicone. O linfoma anaplásico de grandes células ocorre através do desenvolvimento de um seroma, com a formação de derrame periprotético ou por uma infiltração da própria afecção. Para análise destes acometimentos, foi realizada uma revisão da literatura acerca da sintomatologia e fisiopatologia da síndrome autoimune/inflamatória induzida por adjuvantes e linfoma anaplásico de grandes células, pesquisada através dos termos "ASIA breast silicone" "Lymphoma" "Adjuvants" "Immunologic" "Breast Implants" na plataforma PubMed. Analisando os dados obtidos, notou-se que os sintomas da síndrome autoimune/inflamatória induzida por adjuvantes são inespecíficos, como fadiga, mialgia, artralgia, rigidez matinal e suores noturnos, e, portanto, necessitam de atenção. Já o linfoma anaplásico de grandes células se apresenta com dor mamária, derrame periprotético, massa palpável, dentre outras características. Em vista destes aspectos, conclui-se que uma boa investigação deve ser realizada ao surgirem sintomas inespecíficos, independentemente do tempo que a cirurgia foi realizada, uma vez que estas complicações podem ocorrer anos após a cirurgia.

Effects of transversus abdominis plane block on pain, rehabilitation indexes and immune function in patients undergoing laparoscopic colorectal cancer surgery / 中国医师进修杂志

Objective:To observe the effects of ultrasound guided transversus abdominis plane block (TAPB) on pain, rehabilitation indexes and immune function of postoperative in patients undergoing laparoscopic colorectal cancer surgery.Methods:A total of 100 patients undergoing laparoscopic colorectal cancer surgery admitted to Jiading Branch of Shanghai First People′s Hospital/Jiangqiao Hospital of Jiading District and Shanghai First People′s Hospital from February 2020 to February 2021 were selected as the study subjects, including 43 patients performed epidural block (control group) and 57 patients performed TAPB (observation group). The clinical indicators, vital signs parameters, pain degree, immune function in the two groups were compared.Results:The exhausting time, defecation time, getting out of bed time and hospitalization time in observation group were shorter than those in control group: (2.71 ± 0.54) d vs. (2.99 ± 0.66) d, (3.02 ± 0.49) d vs. (3.49 ± 0.56) d, (3.20 ± 0.89) d vs. (3.85 ± 1.08) d, (6.81 ± 0.98) d vs. (7.71 ± 1.08) d, there were statistical differences ( P<0.05). The diastolic blood pressure, systolic blood pressure and heart rate at pre-anesthesia, immediate incision of the skin, end of the surgery between two groups had no significant differences ( P>0.05). The scores of visual analogue scale at 4, 24, 48 and 72 h after surgery in the observation group were significantly lower than those in the control group ( P<0.05). The levels of CD 3+, CD 4+, CD 4+/CD 8+ and IgM after surgery for 3 d in the observation group were higher than those in the control group: 0.512 ± 0.054 vs. 0.487 ± 0.051, 0.280 ± 0.036 vs. 0.222 ± 0.032, 1.36 ± 0.29 vs. 1.17 ± 0.26, (152.53 ± 34.3) kU/L vs. (138.86 ± 31.18) kU/L, there were statistical differences ( P<0.05). Conclusions:TAPB can effectively reduce the degree of postoperative pain and immunosuppression after laparoscopic colorectal cancer surgery, so as to promote postoperative rehabilitation of patients.

Comparación entre inmunomoduladores y crioterapia para el tratamiento de lesiones genitales en mujeres con VPH / Comparison between immunomodulators and cryotherapy for the treatment of genital lesions in women with HPV / Comparação entre imunomoduladores e crioterapia para o tratamento de lesões genitais em mulheres com HPV

El virus del papiloma humano es una infección prevalente, que puede infectar cualquier mucosa del cuerpo y causar verrugas genitales externas o condilomas genitales y cáncer de cuello uterino. El tratamiento es difícil con una alta recurrencia y persistencia de las mismas, lo que afecta mayormente a mujeres jóvenes. El objetivo del presente estudio fue realizar una comparación entre inmunomoduladores y crioterapia para el tratamiento de lesiones genitales en mujeres con VPH. Se realizó una revisión bibliográfica de la literatura científica, entre inmunomoduladores y crioterapia para el tratamiento de lesiones genitales en mujeres con VPH de los últimos 20 años, donde se identificaron publicaciones de revisiones sistemáticas y metaanálisis. Se concluyó que la elección de los inmunomoduladores al igual que la crioterapia es mejor utilizarlos cuando existe lesiones clínicas inducidas por el VPH en la región genital y perianal en mujeres, dependiendo de la cantidad, el tamaño, la gravedad, la ubicación de las verrugas y las preferencias del paciente.

Human papillomavirus is a prevalent infection, which can infect any mucosa of the body and cause external genital warts or genital warts and cervical cancer. Treatment is difficult with a high recurrence and persistence of the same, which mainly affects young women. The objective of the present study was to compare immunomodulators and cryotherapy for the treatment of genital lesions in women with HPV. A narrative bibliographic review of the scientific literature was carried out, between immunomodulators and cryotherapy for the treatment of genital lesions in women with HPV of the last 20 years, where publications of systematic reviews and meta-analyses were identified. It was concluded that the choice of immunomodulators, like cryotherapy, is better used when there are clinical lesions induced by HPV in the genital and perianal region in women, depending on the number, size, severity, location of the warts and patient preferences.

O papilomavírus humano é uma infecção prevalente, que pode infectar qualquer mucosa do corpo e causar verrugas genitais externas ou verrugas genitais e câncer cervical. O tratamento é difícil com alta recorrência e persistência da mesma, que acomete principalmente mulheres jovens. O objetivo do presente estudo foi comparar imunomoduladores e crioterapia para o tratamento de lesões genitais em mulheres com HPV. Foi realizada uma revisão bibliográfica narrativa da literatura científica, entre imunomoduladores e crioterapia para tratamento de lesões genitais em mulheres com HPV dos últimos 20 anos, onde foram identificadas publicações de revisões sistemáticas e metanálises. Concluiu-se que a escolha de imunomoduladores, como a crioterapia, é melhor utilizada quando há lesões clínicas induzidas pelo HPV na região genital e perianal em mulheres, dependendo do número, tamanho, gravidade, localização das verrugas e preferências da paciente.

Eculizumab, a successful treatment for atypical postpartum hemolytic-uremic syndrome: a case report / Eculizumab, un tratamiento exitoso en el síndrome hemolítico-urémico atípico puerperal: un caso clínico

Atypical hemolytic-uremic syndrome (aHUS) is a rare entity characterized by the association of acute kidney failure, thrombocytopenia and microangiopathic hemolytic anemia due to the dysregulation of the alternative pathway of the complement system. It is included within the thrombotic microangiopathies. The following aHUS was developed in the immediate puerperium in the context of severe preeclampsia. The patient was a primiparous woman of 30+1 weeks who required hospitalization for anticonvulsant and hypotensive treatment, and who underwent an emergency cesarean section due to a pathological cardiotocographic pattern. 36 hours after delivery, the patient presented with sudden dyspnea and cognitive deterioration, progressing in a few hours to renal and multiorgan failure. Blood test showed severe anemia, thrombopenia and hypertransaminemia. In view of the fast evolution and severity, it was decided to treat with Eculizumab, although the scientific evidence was very poor. Aside from the supportive treatment performed in the Intensive Care Unit, the patient was successfully treated with Eculizumab, with favorable evolution over the following months and restoration of kidney function, although need for chronic hypotensive treatment remained.

El síndrome hemolítico-urémico atípico (SHUa) es una entidad rara caracterizada por la asociación de insuficiencia renal aguda, trombocitopenia y anemia hemolítica microangiopática debido a la desregulación de la vía alternativa del sistema del complemento. Se incluye dentro de las microangiopatías trombóticas. Se presenta un SHUa que se desarrolló en el puerperio inmediato en el contexto de una preeclampsia grave. La paciente era una primípara de 30+1 semanas que requirió hospitalización para tratamiento anticonvulsivo e hipotensor, y a la que se le practicó una cesárea de urgencia por un patrón cardiotocográfico patológico. A las 36 horas del parto, la paciente presentó una disnea súbita y un deterioro cognitivo progresivo, que evolucionó en pocas horas a un fallo renal agudo y multiorgánico. La analítica mostró anemia severa, trombopenia e hipertransaminemia. Ante la rápida evolución y gravedad, se decidió tratar con Eculizumab, aunque la evidencia científica era escasa. Aparte del tratamiento de soporte realizado en la Unidad de Cuidados Intensivos, la paciente fue tratada con éxito con Eculizumab, con evolución favorable en los meses siguientes y restablecimiento de la función renal, aunque se mantuvo la necesidad de tratamiento hipotensor crónico.

Mieloma múltiple en Chile. Uso de drogas noveles en dos centros nacionales

Background: The incorporation of novel drugs, such as proteasome inhibitors and immunomodulators, improved considerably the survival of patients with multiple myeloma. Aim: To evaluate the effect on survival of proteasome inhibitors and immunomodulators in patients with multiple myeloma in two national hospitals. Material and Methods: Review of clinical records from two hospitals of Santiago. Epidemiological, clinical, laboratory and therapeutic data was obtained from 144 patients with multiple myeloma diagnosed between 2002 and 2016. Results: Information was retrieved from 78 patients at one center and from 66 at the other center. The mean age at diagnosis was 58 and 62 years, the proportion of males was 53% and 52%, and presentation at stage III was 34% and 46%, respectively. The use of novel drugs, mainly bortezomib, was 90% in one of the centers and 3% in the other one. The use of autologous stem-cell transplantation was 47% and 3% respectively. The median overall survival of patients from the centers with and without access to novel drugs was 117 and 71 months respectively (p < 0.05). The five-year overall survival was 93 and 43% respectively (p < 0.05). Conclusions: The use of novel drugs, especially bortezomib, and autologous stem-cell transplantation significantly improved the survival of multiple myeloma patients treated in national hospitals. It is necessary to include them as a first line treatment.

Biomodulina T® como alternativa de tratamiento en el shock séptico en pediatría / Biomodulina T® as an alternative to the treatment of septic shock in pediatrics

Introducción: La sepsis y el shock séptico se encuentran entre las principales causas de morbilidad y mortalidad en la población pediátrica a nivel mundial. Encontrar soluciones alternativas para combatirlas, mediante el desarrollo de agentes inmunomoduladores, ha atraído el interés de investigadores en los últimos 20 años; Cuba cuenta con Biomodulina T®, un potente inmunomodulador. Objetivo: Demostrar que existe evidencia científica que avale la realización de ensayos clínicos controlados para la incorporación de la Biomodulina T® en las pautas de tratamientos de la sepsis en las terapias intensivas pediátricas. Material y Métodos: Se realizó una búsqueda en las bases de datos Medline, PubMed, SciELO, Lilacs, Cochrane Library y Web of Science, entre marzo de 2019 y marzo de 2020; se seleccionaron los 47 artículos de mayor relevancia para esta investigación. Desarrollo: La inmunopatogenia del shock se centra en un fenotipo complejo y alteraciones funcionales, tanto del sistema inmune innato como del sistema adaptativo, con disminución del número de células efectoras, aumento de subpoblaciones de linfocitos inmunosupresores y agotamiento de células T. Biomodulina T® estimula la producción de linfocitos T y robustece la diferenciación de las células linfoblastoides del timo. La práctica médica sugiere que su administración podría ser una estrategia prometedora para la restauración inmune en pacientes pediátricos con shock séptico. Conclusiones: Existe evidencia científica que respalda el uso de Biomodulina T® en pacientes con shock séptico, lo cual sustenta la fiabilidad de realizar ensayos clínicos controlados en población pediátrica para su posterior incorporación en las pautas de tratamientos en las terapias intensivas(AU)

Introduction: Sepsis and septic shock are among the main causes of morbidity and mortality in the pediatric population worldwide. Finding alternative solutions to combat them through the development of immunomodulatory agents has attracted the interest of researchers in the last 20 years; Cuba has Biomodulina T®, a powerful immunomodulator. Objective: To demonstrate that there is scientific evidence that supports the conduction of controlled clinical trials for the incorporation of Biomodulina T® into the treatment guidelines for sepsis in pediatric intensive care therapies. Material and Methods: A search was carried out in the Medline, PubMed, SciELO, Lilacs, the Cochrane Library and the Web of Science databases between March 2019 and March 2020; the 47 most relevant articlesfor this research were selected. Development: The immunopathogenesis of shock focuses on a complex phenotype and functional alterations of both the innate and adaptive immune systems with a decrease in the number of effector cells, an increase in subpopulations of immunosuppressive lymphocytes, and depletion of T cells. Biomodulina T® stimulates the production of T lymphocytes and strengthens the differentiation of lymphoblastoid cells of the thymus; medical practice suggests that its administration could be a promising strategy for immune restoration in pediatric patients with septic shock. Conclusions: There is scientific evidence that supports the use of Biomodulina T® in patients with septic shock, which supports the reliability of conducting controlled clinical trials in the pediatric population for its subsequent incorporation into treatment guidelines in intensive care therapies(AU)

Immunosuppressors and immunomodulators in Neurology - Part I: a guide for management of patients underimmunotherapy / Imunossupressores e imunomoduladores em Neurologia - Parte I: um guia para o manejo de pacientes em imunoterapia

ABSTRACT For patients with autoimmune diseases, the risks and benefits of immunosuppressive or immunomodulatory treatment are a matter of continual concern. Knowledge of the follow-up routine for each drug is crucial, in order to attain better outcomes and avoid new disease activity or occurrence of adverse effects. To achieve control of autoimmune diseases, immunosuppressive and immunomodulatory drugs act on different pathways of the immune response. Knowledge of the mechanisms of action of these drugs and their recommended doses, adverse reactions and risks of infection and malignancy is essential for safe treatment. Each drug has a specific safety profile, and management should be adapted for different circumstances during the treatment. Primary prophylaxis for opportunistic infections and vaccination are indispensable steps during the treatment plan, given that these prevent potential severe infectious complications. General neurologists frequently prescribe immunosuppressive and immunomodulatory drugs, and awareness of the characteristics of each drug is crucial for treatment success. Implementation of a routine before, during and after use of these drugs avoids treatment-related complications and enables superior disease control.

RESUMO Pacientes com doenças autoimunes exigem uma constante preocupação com os riscos e benefícios do tratamento imunossupressor ou imunomodulador. O conhecimento das rotinas no uso de cada uma dessas drogas é fundamental para o bom desfecho clínico, evitando a piora da doença ou efeitos colaterais. As drogas imunossupressoras e imunomoduladoras agem em diferentes pontos da resposta imunológica a fim de controlar a doença para qual são indicadas. O conhecimento do mecanismo de ação, principais posologias, efeitos adversos e os riscos de infecções e neoplasias relacionadas ao uso dessas medicações são fundamentais para um tratamento seguro. Cada uma delas apresenta um perfil específico de complicações e o manejo deve ser individualizado em diferentes cenários ao longo do seguimento do paciente. O uso de medicações para profilaxia primária de infecções e a vacinação são pontos essenciais no planejamento do tratamento, prevenindo potenciais complicações infecciosas ao longo do acompanhamento. O uso de imunossupressores e imunomoduladores é uma frequente realidade no dia-a-dia do neurologista, e o conhecimento das características de cada droga é crucial para o sucesso do tratamento. A realização de uma rotina antes, durante e depois do uso dessas medicações evita complicações relacionadas com o tratamento e alcança um melhor controle da doença.

The effect of ventriculoscopy combined with laparoscopy in ventriculoperironeal shunt on the treatment effect, inflammatory factors and immune function in patients with hydrocephalus / 中国医师进修杂志

Objective:To investigate the therapeutic effect of ventriculoscopy combined with laparoscopy in ventriculoperironeal shunt (VPS) on the treatment effect, inflammatory factors and immune function in patients with hydrocephalus.Methods:A retrospective study was conducted on 76 patients with hydrocephalus in Traditional Chinese Medicine Hospital of Jining from March 2017 to September 2019, and they were divided into observation group (39 cases) and control group (37 cases) according to different treatment procedures. The control group performed traditional VPS, and the observation group performed ventricoscopy combined with laparoscopy in VPS. The incidence of postoperative complications and the treatment effect at 6 months after the operation, serum inflammatory factors tumor necrosis factor-α (TNF-α), interleukin (IL)-10, IL-6, immune function indexes CD 3+, CD 4+, CD 4+/CD 8+before and 1 d and 3 d after the operation, Glasgow Outcome Scale (GOS) and Modified Rankin Scale (MRS), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and Generic Quality of Life Inventory 74 (GQOL-74) before operation, 3 and 6 months after operation were compared between the two groups. Results:The total effective rate in the observation group at 6 months after operation was higher than that in the control group: 94.9% (37/39) vs. 73.0% (27/37), and the difference was statistically significant ( χ2 = 0.848, P<0.05). The GOS scores in the observation group were higher than those in the control group at 3 months and 6 months after surgery: (3.68 ± 0.49) scores vs. (3.02 ± 0.51) scores, (4.17 ± 0.24) scores vs. (3.59 ± 0.43) scores; and the MRS and NIHSS scores were lower than those in the control group: (2.05 ± 0.15) scores vs. (2.84 ± 0.17) scores and (1.62 ± 0.11) scores vs. (2.17 ± 0.14) scores, (12.97 ± 3.82) scores vs. (16.05 ± 4.61) scores and (10.90 ± 2.75) scores vs. (13.84 ± 3.29) scores; and the differences were statistically significant ( P<0.05). The serum levels of TNF-α and IL-6 in the observation group were lower than those in the control group at 1 and 3 d after surgery, and IL-10 level was higher than that in the control group, and the differences were statistically significant ( P<0.05). The CD 3+, CD 4+, and CD 4+/CD 8+ levels in the observation group were higher than those in the control group at 1 and 3 d after operation, and the differences were statistically significant ( P<0.05). The postoperative complications in the observation group was lower than that in the control group: 29.7% (11/37) vs. 10.3% (4/39), and the difference was statistically significant ( χ2 = 4.383, P<0.05). The BI and GQOL-74 scores in the observation group at 3 and 6 months after operation were higher than those in the control group ( P<0.05). Conclusions:The combination of ventricoscopy and laparoscopic in VPS can reduce the impact on immune function by reducing the inflammatory stress response, reduce the occurrence of postoperative complications, and further promote the improvement of prognosis.

Differential expression and significance of Foxp3, TGF-β1 and IL-2 in peripheral blood of patients with coal-burning arsenic poisoning / 中华地方病学杂志

Objective To investigate the expression of transcription factor forkhead/winged helix transcription factor 3 (Foxp3),immune factor transforming growth factor-beta 1 (TGF-β1),and T-lymphocyte activation related factor interleukin-2 (IL-2) in peripheral blood of patients with coal-burning arsenic poisoning,and to analyze the effects of arsenic exposure on immune function.Methods A case-control study was conducted to investigate 149 cases [94 males and 55 females,(50.69 ± 6.14) years old] of arsenic poisoning in Yuzhang coalburning arsenic poisoning area,southwestern Guizhou Province,and the cases were diagnosed based on the "Diagnosis of Endemic Arsenicosis" (WS/T 211-2015) and confirmed by clinical review.According to skin damage,the patients were divided into mild arsenic poisoning group (39 cases),moderate arsenic poisoning group (54 cases) and severe arsenic poisoning group (56 cases);and 41 cases [12 males and 29 females,(45.76 ± 7.88) years old] of non-arsenic exposed residents from 12 km of Yuzhang coal-burning area were selected as control group.Morning urine and peripheral blood samples were collected with informed consent.Urine arsenic content was measured by inductively coupled plasma mass spectrometry (ICP-MS).Urine arsenic was corrected by creatinine (Cr).Detection of regulatory T cell (Treg)-specific transcription factor Foxp3 gene expression in human peripheral blood was done by real-time fluorescence quantitative PCR,and the levels of Treg-related immune factor TGF-β1 and IL-2 in serum were detected by enzyme linked immunosorbent assay (ELISA).Results The urinary arsenic contents [median (quartile):29.13 (19.75-54.50),31.81 (17.52-53.31),30.51 (18.35-45.76) μg/g Cr] in each arsenic poisoning group were higher than that in the control group [21.62 (17.65-28.44) μg/g Cr,P ＜ 0.05].The expression levels of Foxp3 mRNA in peripheral blood of each arsenic poisoning group [median (quartile):0.58 (0.17-1.27),0.32 (0.17-0.61),0.33 (0.13-0.62)] were significantly lower than that in the control group [0.87 (0.64-1.50),P ＜ 0.05];compared with mild arsenic poisoning group,the expression of Foxp3 mRNA in peripheral blood of moderate and severe arsenic poisoning groups decreased (P ＜ 0.05).The contents of serum TGF-β1 [(13.14 ± 5.19),(12.85 ± 5.51),(12.78 ± 4.95) μg/L] in each arsenic poisoning group were significantly higher than that in the control group [(3.90 ± 1.53) μg/L,P ＜ 0.05].The levels of IL-2 in serum of each arsenic poisoning group [(9.85 ± 5.38),(11.64 ± 6.40),(12.27 ± 6.19) ng/L] were lower than that in the control group [(34.30 ± 4.84) ng/L,P ＜ 0.05];the serum level of IL-2 in severe arsenic poisoning group was higher than that in mild arsenic poisoning group (P ＜ 0.05).Conclusions Arsenic exposure can cause abnormal changes of Treg-specific transcription factor Foxp3 and related immune factors TGF-β1 and IL-2 in peripheral blood of patients.It is suggested that Treg dysfunction may be related to arsenic poisoning.

Research advances in the pathogenesis of autoimmune hepatitis / 临床肝胆病杂志

Autoimmune hepatitis (AIH) is a progressive chronic inflammatory liver disease with unknown etiology. At present, genetic susceptibility and environmental factors are universally recognized as the etiological factors for AIH. With the deepening of research in recent years, other etiological factors, such as immune cells, immune factors, liver transplantation, and drugs, have attracted more and more attention. This article briefly describes related research findings in the past five years.

Research advances in anti-hepatitis B virus drugs / 临床肝胆病杂志

Hepatitis B virus (HBV) infection has always been a great threat to public health, and about 2 billion people in the world have the history of HBV infection. Chronic HBV infection can lead to chronic hepatitis, liver cirrhosis, and even hepatocellular carcinoma. At present, nucleoside analogues (NAs) and interferons (IFNs) have been approved for the treatment of chronic hepatitis B in China. Long-term use of NAs has good safety and tolerability and can effectively inhibit viral replication and reduce the risk of liver-related complications, but there are still the issues such as long and uncertain course of treatment, risk of drug resistance, and recurrence after drug withdrawal. IFNs have severe side effects with limited seroconversion and cure rate. Therefore, the research and development of new antiviral drugs with different targets of HBV is of vital importance for the treatment of chronic HBV infection. This article summarizes the research advances in anti-HBV drugs with different targets, so as to provide a reference for clinical and research work.

Tacrolimus for ulcerative colitis in children: a multicenter survey in Japan

BACKGROUND/AIMS: Tacrolimus is effective for refractory ulcerative colitis in adults, while data for children is sparse. We aimed to evaluate the effectiveness and safety of tacrolimus for induction and maintenance therapy in Japanese children with ulcerative colitis.METHODS: We retrospectively reviewed the multicenter survey data of 67 patients with ulcerative colitis aged < 17 years treated with tacrolimus between 2000 and 2012. Patients’ characteristics, disease activity, Pediatric Ulcerative Colitis Activity Index (PUCAI) score, initial oral tacrolimus dose, short-term (2-week) and long-term (1-year) outcomes, steroid-sparing effects, and adverse events were evaluated. Clinical remission was defined as a PUCAI score < 10; treatment response was defined as a PUCAI score reduction of ≥ 20 points compared with baseline.RESULTS: Patients included 35 boys and 32 girls (median [interquartile range] at admission: 13 [11–15] years). Thirty-nine patients were steroid-dependent and 26 were steroidrefractory; 20 had severe colitis and 43 had moderate colitis. The initial tacrolimus dose was 0.09 mg/kg/day (range, 0.05–0.12 mg/kg/day). The short-term clinical remission rate was 47.8%, and the clinical response rate was 37.3%. The mean prednisolone dose was reduced from 19.2 mg/day at tacrolimus initiation to 5.7 mg/day at week 8 (P< 0.001). The adverse event rate was 53.7%; 6 patients required discontinuation of tacrolimus therapy.CONCLUSIONS: Tacrolimus was a safe and effective second-line induction therapy for steroid-dependent and steroid-refractory ulcerative colitis in Japanese children.

Clinical effects of Xiaoer-Chaigui-Tuire granules in the treatment of mycoplasma pneumoniae pneumonia / 国际中医中药杂志

Objective To study the effects of Xiaoer-Chaigui-Tuire granules in the treatment of mycoplasma pneumoniae pneumonia (MPP). Methods A total of 200 children with mycoplasma pneumoniae pneumonia which conformed to the standard of admission were randomly divided into the control group (n=100) and the treatment group (n=100). The control group were treated with azithromycin, and the treatment group were treated with Xiaoer-Chaigui-Tuire granules combined with azithromycin. The temperature recovery time, cough disappeared time, asthma disappeared time, lungs rale disappeared time of the two groups were observed and compared. The serum IgG, IgM and IgA levels were detected by ELISA and the CD3, CD4, CD8 cell ratio of peripheral blood were detected by flow cytometry. Results The total effect rate of the treatment group was 95.0％ (95/100), significantly higher than 80.0％ (80/100) of the control group (χ2=10.286, P=0.001). The fever disappeared time (2.5 ± 0.3 d vs. 4.2 ± 0.9 d, t=17.004), cough disappeared time (3.0 ± 0.6 d vs. 4.5 ± 0.5 d, t=19.861), asthma disappeared time (3.1 ± 1.1 d vs. 4.0 ± 1.3 d, t=5.046), lungs rale disappeared time (4.2 ± 1.0 d vs. 8.4 ± 1.5 d, t=22.988) and of the treatment group were significantly lower than those of the control group (P<0.01). After treatment, the IgG (9.47 ± 1.63 g/L vs. 7.05 ± 1.46 g/L, t=11.059), IgM (1.87 ± 0.52 g/L vs. 1.53 ± 0.48 g/L, t=4.804) and IgA (1.79 ± 0.61 g/L vs. 1.20 ± 0.53 g/L, t=7.301) of the treatment group were significantly higher than those of the control group (P<0.01). After treatment, the blood CD3 levels (78.83％ ± 5.20 ％ vs. 57.48％ ± 4.09％, t=32.271), CD4 levels (40.27％ ± 3.42％ vs. 30.54％ ± 3.27％, t=20.563) of the treatment group were significantly higher than the control group, and the blood CD8 levels (21.15％ ± 2.90％ vs. 30.14％ ± 3.85％, t=18.651) of the treatment group were significantly lower than the control group (P<0.01). There was no significant difference in the incidence of adverse events between two groups (χ2=0.649, P=0.421). Conclusions The Xiaoer-Chaigui-Tuire granules combined with azithromycin for children with MPP has a good efficacy and low adverse events. They could relieve the clinical symptoms and improve the children's immune function.

Factors associated with adherence to immunomodulator treatment in people with multiple sclerosis

Abstract To determine the association between factors and adherence to immunomodulator treatment in people with multiple sclerosis treated in reference centers. Cross-sectional study conducted with 188 people who used immunomodulators in three reference centers in Ceará from March to July 2012. Adherence was assessed using the Moriskscale and factors were assessed using a questionnaire addressing socioeconomic and personal characteristics, the disease, the use of immunomodulator and educational activities. The determination of the association was expressed in crude and adjusted odds ratio with a 95% confidence interval. Adherence rate was 46% and after the logistic regression model the adherence to immunomodulator treatment was positively associated with the following factors: age 18-38 years, time of diagnosis and treatment between 6 and 24 months, 0-3.5 score in the Expanded Disability Status Scale, perception of treatment benefits, intrinsic and extrinsic motivation, phone contact with the doctor and not missing the return visit. This study is important because it allowed to determine the association between factors and adherence to immunomodulator treatment in multiple sclerosis, contributing to prevention and control actions.

Cardiac abnormalities in patients with acute intracerebral hemorrhage: pathophysiological mechanism and clinical manifestation / 国际脑血管病杂志

The mortality and disability of patients occurring cardiac abnormalities in the acute stage of spontaneous intracerebral hemorrhage increase significantly.It has been gradually paid attention to.This article reviews the pathophysiological mechanism and clinical manifestation of abnormal cardiac manifestations in the acute stage of spontaneous intracerebral hemorrhage.

The differential expression and significance of regulatory T cell and T helper 17 related immunologic factors in peripheral blood of arsenic-exposed rats / 中华地方病学杂志

Objective To investigate the differential expression levels and significance of regulatory T cell (Treg) and T helper 17 (Th17) related immunologic factors in peripheral blood of arsenic-exposed rats.Methods Thirty-two Wistar rats were numbered by weight,randomly divided into four groups [control,low (1.25 ml/kg),medium (2.50 ml/kg),and high (5.00 ml/kg)],8 rats per group.Rats in control group were given oral gavage of deionized water,and low,medium and high arsenic exposed groups were given oral gavage doses of 2.00 g/L sodium arsenite (NaAsO2) according to their body weight for 6 days every week.After 4 months,the urine and peripheral blood samples of rats were collected,urinary arsenic (uAs) was detected by inductively coupled plasma-mass spectrometry (ICP-MS),the results were shown in [median (minimum and maximum)],uAs was corrected by urinary creatinine (uCr),the unit was μg/g Cr;enzyme-linked immune-sorbent assay (ELISA) was applied to detect the levels of Treg,Th17,T lymphocytes activation related immunologic factors [interleukin-10 (IL-10),transforming growth factor beta1 (TGF-31),IL-17,IL-6,IL-2],the results were shown in (x) ± s.Results The uAs of the rats was compared between control,low,medium,and high arsenic exposed groups [7.50 (3.16-9.81),72.34 (62.34-106.63),209.15 (154.41-232.20),369.73 (289.50-516.55) μg/g Cr],the differences were statistically significant (F =337.55,P ＜ 0.05).IL-10 [(85.03 ± 7.11),(93.96 ± 8.14),(97.48 ± 6.23),(93.47 ± 4.41) ng/L],TGF-β1 [(72.88 ± 2.96),(81.45 ± 8.15),(86.08 ± 7.55),(90.29 ± 5.35) ng/L],IL-17 [(18.15 ± 3.66),(25.54 ± 5.59),(31.48 ± 5.74),(37.25 ± 7.36) ng/L],IL-6 [(83.68 ± 8.48),(85.14 ± 7.11),(89.78 ± 5.36),(93.48 ± 5.77) ng/L],and IL-2 [(80.65 ± 6.90),(73.86 ± 8.00),(69.93 ± 7.77),(62.06 ± 9.82) ng/L] of the rats were compared between control,low,medium,and high arsenic exposed groups,the differences were statistically significant (F =5.094,11.054,16.249,3.474,5.119,all P ＜ 0.05).There were positive correlations between uAs and TGF-β1,IL-17 concentration (r =0.723,0.605,all P ＜ 0.01),while IL-2 showed a negative correlation (r =-0.484,P ＜ 0.05).Concltsion Arsenic exposure could affect the secretion of Treg and Th17 related immunologic factors,so as to the imbalance of anti-inflammatory and pro-inflammatory,which may play a role in the formation and development of arsenic-related immune injury.

Analysis of the change of vaginal microenvironment in pregnant women with preterm premature rupture of ;the membranes / 中国基层医药

Objective To study the vaginal microenvironment in pregnant women with preterm premature rupture of the membranes,and to explore the change of vaginal microenvironment in pregnant women with preterm premature rupture of the membranes.Methods 1 16 women with preterm premature rupture of the membranes were selected as preterm premature rupture of the membranes group,1 16 women with normal pregnancy outcomes were selected as control group.The vaginal pH value,vaginal lactobacilli,vaginal sialidase and HD5,IgE and SIgA levels were observed.Results At 28 weeks of pregnancy,the vaginal PH value,sialidase detection rate and HD5,IgE,SIgA levels of preterm premature rupture of the membranes group were higher than those of the control group,but there were no significant differences between the two groups(t=1.037,χ2 =1.052,t=1.282,1.051,1.861,all P>0.05).At pregnant 36 weeks,the vaginal pH value,sialidase detection rate and HD5,IgE,SIgA levels of preterm premature rupture of the membranes group[(4.13 ±0.22),71.4%,(12.53 ±1.55)pg/mL,(338.84 ±1.67)ng/mL, (53.44 ±1.57)μg/mL]were higher than those of the control group[(3.79 ±0.25),13.8%,(8.77 ±3.17)pg/mL, (167.43 ±3.66)ng/mL,(37.59 ±1.85)μg/mL],the differences were statistically significant(t=12.331,χ2 =24.816,t=5.258,9.469,7.357,all P0.05).At 36 weeks gestation,the vaginal lactobacilli detection rate of preterm premature rupture of the membranes group was lower than that of the control group,the difference was statistically significant (χ2 =19.545,P<0.05).Conclusion Preterm premature rupture of the membranes pregnant vaginal pH value increases,the detection rate of vaginal lactobacilli decreases,vaginal sialidase detection rate increases,vaginal immune factors HD5,IgE,SIgA level increases.

Optimal maintenance and consolidation therapy for multiple myeloma in actual clinical practice

Multiple myeloma is an incurable malignant plasma cell-originating cancer. Although its treatment outcomes have improved with the use of glucocorticoids, alkylating drugs, and novel agents, including proteasome inhibitors (bortezomib and carfilzomib) and immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide), relapse remains a serious problem. Strategies to improve outcomes following autologous stem cell transplantation and frontline treatments in non-transplant patients include consolidation to intensify therapy and improve the depth of response and maintenance therapy to achieve long-term disease control. Many clinical trials have reported increased progression-free and overall survival rates after consolidation and maintenance therapy. The role of consolidation/maintenance therapy has been assessed in patients eligible and ineligible for transplantation and is a valuable option in clinical trial settings. However, the decision to use consolidation and/or maintenance therapy needs to be guided by the individual patient situation in actual clinical practice. This review analyzes the currently available evidence from several reported clinical trials to determine the optimal consolidation and maintenance therapy in clinical practice.