Early changes within the lymphocyte population are associated with the long term prognosis in severely injured patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the relationship between early lymphocyte responses and the prognosis in severely injured patients.@*METHODS@#Consecutive patients with severe trauma who were treated in Peking University People's Hospital Trauma Medical Center between June 2017 and June 2020 were enrolled in this restropective chart-review study. According to the responses of lymphocyte after severe injury, the patients were divided into three groups, group 1: lymphopenia-returned to normal; group 2: persistent lymphopenia; group 3: never lymphopenic, and the outcome of 28 d were recorded. Clinical data such as gender, age, base excess, mechanism of injury, Glasgow coma scale (GCS), injury severity score (ISS) and massive blood transfusion were collected. Perform statistical analysis on the collected clinical data to understand the trend of lymphocyte changes in early trauma and the relationship with prognosis. In order to eliminate the interference of age, stratification was carried out according to whether the age was ≥ 65 years old, in different age groups, they were grouped according to whether the length of stay was ≥ 28 d, and the relationship between lymphocyte trend and length of stay was discussed.@*RESULTS@#A total of 83 patients were included, 66 males and 17 females. The main injury mechanisms were traffic accident injuries and high-altitude fall injuries. The average ISS was (30±11) points. 65 patients had lymphopenia on the day of injury, 32 of them returned to normal on the 5th day, and the rest did not recover; the other 18 patients had normal lymphocyte levels after injury. Patients which are failure to normalize lymphopenia within the first 5 days following admission was related with the long hospitalization time and higher 28 d mortality rate. After further stratification by age, failure to normalize lymphopenia within the first 5 days following admission in the elderly group (age ≥65 years) was a risk factor for prolonged hospital stay (≥28 d), P=0.04. While in younger group, a high level of neutrophils within the first 5 d following admission was a risk factor for bad outcome.@*CONCLUSION@#A failure to normalize lymphopenia in severely injured patients is associated with significantly higher mortality and longer hospital stay. This study reveals lymphocytes can be used as a reliable indicator for the prognostic evaluation.

Clinical features of children with / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of children with @*METHODS@#A total of 310 MPP children who were hospitalized and underwent bronchoalveolar lavage from June 2018 to June 2019 were enrolled and divided into two groups: simple MPP group with 241 children (without peripheral lymphocytopenia) and MPP + peripheral lymphocytopenia group with 69 children. The two groups were compared in terms of clinical data and treatment outcome.@*RESULTS@#Compared with the simple MPP group, the MPP + peripheral lymphocytopenia group had significantly longer duration of fever and length of hospital stay and significant increases in C-reactive protein, lactate dehydrogenase, and @*CONCLUSIONS@#Children with MPP and peripheral lymphocytopenia tend to have more severe immunologic injury. Peripheral blood lymphocyte count may be used to evaluate the severity of MPP.

Characteristics of Hospitalized Children with 2009 Pandemic Influenza A (H1N1): A Multicenter Study in Korea

The majority of Korean patients with pandemic influenza A (H1N1) during the 2009 epidemic were under 20 yr of age. The limited data on the clinical characteristics of these children led us to conduct a case note-based investigation of children admitted to 6 university hospitals with 2009 H1N1 influenza. A total of 804 children was enrolled. The median age was 5 yr; 63.8% were males; and 22.4% had at least one chronic underlying disease. Ninety-five of the patients (11.8%) were critically ill and they suffered more from shortness of breath, dyspnea and lymphopenia than the other patients. Among all the patients, 98.8% were treated with antivirals and 73% received treatment within 48 hr of illness onset. All the enrolled patients are alive and appear to have had good outcomes, probably due to the early intervention and antiviral treatment. This study deals with hospitalized children whose diagnoses of influenza A (H1N1) were confirmed, and therefore provides important new information about the clinical patterns of children with influenza A (H1N1) in Korea.

Sleep deprivation reduces the lymphocyte count in a non-obese mouse model of type 1 diabetes mellitus

The objective of the present study was to determine whether sleep deprivation (SD) would promote changes in lymphocyte numbers in a type 1 diabetes model (non-obese diabetic, NOD, mouse strain) and to determine whether SD would affect female and male NOD compared to Swiss mice. The number of lymphocytes in peripheral blood after 24 and 96 h of SD (by multiple platform method) or equivalent period of time in home-cage controls was examined prior to the onset of diabetes. SD for 96 h significantly reduced lymphocytes in male Swiss mice compared to control (8.6 ± 2.1 vs 4.1 ± 0.7 10³/æL; P < 0.02). In male NOD animals, 24- and 96-h SD caused a significant decrease of lymphocytes compared to control (4.4 ± 0.3 vs 1.6 ± 0.5; P < 0.001 and 4.4 ± 0.3 vs 0.9 ± 0.1 10³/æL; P < 0.00001, respectively). Both 24- and 96-h SD induced a reduction in the number of lymphocytes in female Swiss (7.5 ± 0.5 vs 4.5 ± 0.5, 4.4 ± 0.6 10³/æL; P < 0.001, respectively) and NOD mice (4 ± 0.6 vs 1.8 ± 0.2, 1.2 ± 0.4 10³/æL; P < 0.01, respectively) compared to the respective controls. Loss of sleep induced lymphopenia in peripheral blood in both genders and strains used. Since many cases of autoimmunity present reduced numbers of lymphocytes and, in this study, it was more evident in the NOD strain, our results suggest that SD should be considered a risk factor in the onset of autoimmune disorders.

Unusual absence of neurologic symptoms in a six-year old girl with ataxia-telangiectasia.

Ataxia-telangiectasia (A-T) is a rare multisystem, neurodegenerative genetic disorder. We present a case of a 6-year-old girl who had a history of frequent respiratory infections and also had ocular and immunological features of this syndrome. The absence of neurological symptoms, which is very unusual for a patient of this age, raised many difficulties in the diagnosis of the disease. It is concluded that a normal neurological assessment must not exclude the diagnosis of A-T and delay the proper interventional measures.

Sarampión en adultos: características clínicas en 25 pacientes hospitalizados / Measles in adults: clinical data in 25 hospitalized patients

Introducción: Durante la epidemia de sarampión en México de 1989-1990, se estudió a 25 pacientes adultos que requirieron de hospitalización. Material y métodos: Se revisaron en forma retrospectiva los expedientes hospitalarios de pacientes que tenían un cuadro clínico consistente con sarampión (fiebre >38ºC, exantema generalizado descendente y la presencia de, por lo menos, uno de los siguientes: tos, coriza o conjuntivitis) para conocer las características clínicas y de laboratorio. Resultados: Nueve pacientes eran del sexo masculino y 16 del sexo femenino. La edad promedio fue de 22.5 años (rango 15 a 33 años). Al momento del ingreso, 17 pacientes (68 por ciento) tenían exantema de Koplick. Ocho pacientes referían haber sido previamente vacunados contra el sarampión. Ningún paciente tenía enfermedad inmunosupresiva de base. La cuenta leucocitaria promedio fue de 5,344/µL con linfopenia (media = 890/µL; mediana = 648/µL). En los 23 pacientes en los que se realizaron pruebas de funcionamiento hepático, éstas se encontraban alteradas, siendo la deshidrogeneasa láctica (DHL) la enzima que se encontraba más alterada y que se correlacionó en forma estadísticamente significativa con la presencia de complicaciones (p= 0.001). Las complicaciones más frecuentes fueron: neumonía intersticial (55 por ciento), hepatitis (33 por ciento), otitis (16 por ciento), sinusitis (16 por ciento) y neumonía bacteriana (14 por ciento). Ningún paciente falleció. Conclusiones: Si bien el sarampión es una enfermedad de la infancia, puede presentarse en adultos, incluso en quienes refieren haber sido inmunizados. Las complicaciones son frecuentes a aquellos que requieren de hospitalización, y la elevación de la DHL se asocia con la presencia de complicaciones

Absolute lymphocytopenia as a diagnostic aid in bronchogenic carcinoma.

Total lymphocyte count and lymphocyte percentage were calculated in a group of 26 patients of Bronchogenic carcinoma and compared with the values in 22 cases of pulmonary tuberculosis. Patients of Bronchogenic carcinoma had a significant lymphocytopenia as compared to patients of tuberculosis. It is inferred that this peripheral lymphocytopenia can be used as a possible diagnostic pointer in patients of Bronchogenic carcinoma.

Histoplasmosis diseminada subaguda asociada a linfopenia idiopática / Subacute disseminated histoplasmosis associate to idiopathyc lymphopenia

Se presenta el caso de una mujer de 20 años de raza blanca, procedente de San Francisco (Provincia de Córdoba) que fue internada por padecer una histoplasmosis diseminada subaguda que presentó algunas características habitualmente observadas en el SIDA. Los estudios realizados permitieron excluir a la infección por HIV como responsable de la disminución continua y progresiva de linfocitos CD4+. La enferma fue tratada con itraconazol con buena respuesta clínica, pero presentó una recidiva 3 meses después de haber interrumpido la primera serie de tratamiento. Consideramos que este caso puede ser ubicado dentro del síndrome de inmunodeficiencia adquirido no causado por el HIV

Efeito imediato da radioterapia sobre as populaçöes de linfócitos T e B em pacientes com câncer de mama / Immediate effect of radiotherapy on T and B lymphocyte population in breast cancer patients

A radioterapia para o câncer da mama como para os de outros órgâos induz uma linfopenia significante. Em estudos anteriores de outros autores, há uma grande controvérsia sobre as proporçöes de diminuiçäo das populaçöes T e B. Quantificando os linfócitos T por rosetas E e os linfócitos B por imunofluorescência direta, observamos diminuiçäo semelhante das populaçöes. Pacientes com ou sem cirurgia prévia responderam do mesmo modo à radioterapia. Pacientes com linfopenia (<1500mm3) prévia à radioterapia sofrem reduçäo significativamente menor de ambas as populaçöes. Seis a oito semanas após a radioterapia já há recuperaçäo significante dos números de linfócitos T somente nas pacientes com mais de 60 anos.

Kinetics of lymphocyte subpopulations in dengue hemorrhagic fever/dengue shock syndrome.

A kinetic study of lymphocyte subpopulations was performed in 61 dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) patients aged 8 months to 12 years and in 59 age-matched normal controls. There were 36 patients in grade 2 and 25 patients in grade 3 of the disease severity. The studies were performed on febrile stage, the day of subsidence of fever or shock stage, 3 subsequent days after subsidence of fever or shock, and once on the recovery stage (approximately 14-18 days after subsidence of fever or shock). The study revealed that the absolute total lymphocytes, CD3+, CD4+, CD8+ and HNK-1+ cells were decreased on febrile stage and their lowest values were noted on the first day of subsidence of fever or shock, while B1+ cells were in the normal range. Thereafter, all lymphocyte subpopulations were increased. The total lymphocytes, B1+ and CD8+ cells were rapidly increased and were above normal value on day 2 after subsidence of fever or shock (early convalescence), then gradually declined to the normal range. In contrast, CD3+, CD4+ and HNK-1+ cells were increased gradually and reached their normal values on day 2 after subsidence of fever or shock. The T4:T8 ratio began to reverse on the day of subsidence of fever or shock, reached its peak on day 2 after shock and returned to normal ratio rapidly thereafter. Thus, the absolute lymphopenia on the day of shock was due to the decrement or T cells (both CD4+ and CD8+ cells) and HNK-1+ cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Anormalidades hematológicas en el lupus eritematoso generalizado / Hematologic abnormalities in systemic lupus erythematosus

El lupus eritematoso generalizado (LEG) es un padecimiento que frecuentemente cursa con anormalidades hematológicas. De 46 pacientes con LEG activo atendidos por el Servicio de Reumatología, el 74% cursó con anemia, que fue hemolítica en el 13% del grupo total. La leucopenia con linfopenia menor de 1500/ul se observó en la mitad de los casos. En el 30% existió trombocitopenia que curso con púrpura en el 43%. En un paciente se identificó un anticoagulante circulante. De 24 enfermos con púrpura trombocitopénica inmune (PTI) secundaria a LEG (88% mujeres), en el 60% de ellos la PTI precedió al diagnóstico de LEG por períodos que oscilaron entre 1 y 20 meses. Las manifestaciones clínicas del LEG fueron: artritis (96%), cutáneas (50%), vasculitis (30%), siendo poco frecuente la presencia de úlceras en mucosas, serositis, fiebre y afeccion visceral. Los anticuerpos antinucleares fueron positivos en el 83% con patrón homogéno en la mitad de los casos. Las células L.E. fueron positivas en el 25% y el VDRL en el 50%. No se registraron descensos anormales de las fracciones 3 y 4 del complemento. La investigación de anticuerpos plaquetarios fue positiva en todos los casos y en trs enfermos la PTI se asoció con anemia hemolítica Coombs positivo. Todos los pacientes respondieron a la terapia esteroidea y la remisión completa se obtuvo en el 72%. En 14 enfermos con enmia hemolítica autoinmune (AHA) secundaria a LEG, la enfermedad hemolítica precedió al LEG en el 57% de los casos. Las manifestaciones clínicas que sugirieron el diagnóstico de LEG fueron: fiebre, serosis y vasculitis en el 75%. La artritis y las manifestaciones cutáneas se encontraron en el 30%. Los anticuerpos antinucleares fueron positivos en el 75%, las células LE en el 36% y el VDRL en el 50%. En los dos tercios de los pacientes existió hiperglobulenemia y el 21% cursó con hipocomplementemia. El Coombs directo fue positivo en todos los enfermos siendo el anticuerpo una IgG con especificidad para el Rh en el 66% de los casos. La enfermedad hemolítica fue controlada con corticoesteroides, obteniendo remisión completa en el 64% de los enfermos