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Objective:To analyze the clinical characteristics and prognosis of patients with AIDS-related lymphoma (ARL).Methods:The clinical data of 84 patients with ARL admitted in the First Affiliated Hospital Zhejiang University School of Medicine from March 2013 to October 2021 were retrospectively reviewed, and the influencing factors for prognosis of patients were analyzed by Cox proportional risk regression model.Results:Non-Hodgkin’s lymphoma accounted for 95.2% (80/84) of all cases; 52.3% (44/84) of the patients presented with B symptoms of lymphoma such as fever, night sweats, and weight loss, and 84.5% (71/84) of them were classified as stage Ⅲ~Ⅳ by Ann Arbor staging; 58.0% (47/81) patients had CD4 + T cell count ≤200/μL at baseline; 30 (35.7%) patients had pulmonary infection, 11 (13.1%) patients had digestive tract infection, and 21.4% (18/84) patients had sepsis. The 1-year survival rate of 84 patients was 70.2% (59/84). Multivariate Cox survival analysis showed that International prognostic index (IPI) score >3 ( HR=5.094, 95% CI 1.877-13.824, P=0.001) was an independent risk factors and rituximab treatment ( HR=0.354, 95% CI 0.152-0.823, P=0.016) was an independent protective factor for the prognosis of patients with ARL. Conclusions:The clinical manifestations of ARL are diverse, and it is often diagnosed in the late stage of the disease with adverse prognosis. IPI score and Rituximab treatment are key prognostic factors in patients with ARL.
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Acquired immune deficiency syndrome (AIDS) can cause various opportunistic infections clinically due to severe defects in the body’s cellular immune function. Cryptococcosis is a common serious opportunistic infection in AIDS patients. With the promotion and popularization of high activity antiretroviral therapy (HAART) programs worldwide, the mortality rate of AIDS-related cryptococcosis has been significantly decreased. After initiating antiviral therapy, some patients experienced recurrence and aggravation of clinical symptoms during anti-cryptococcal treatment. The body has an inflammatory response to the excessive immune regulation of cryptococcal antigens, which is called cryptococcus-related immune reconstitution inflammatory syndrome (C-IRIS). C-IRIS seriously affects the quality of life and prognosis of patients. This article reviews the clinical features, pathogenesis and the latest treatment and management strategies of C-IRIS in AIDS patients.
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Objective To systematically explore the efficacy of four intervention regiments including desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs in the treatment of monosymptomatic nocturnal enuresis in children by network meta-analysis. Methods The databases of PubMed, Cochrance Library, EMBase and Web of Science were systematically searched and retrieved upto August 1, 2017. Included were the randomized controlled trials (RCTs) which had any two or more of four intervention regiments (desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs) for treatment of monosymptomatic nocturnal enuresis in children. The literature was screened according to the established inclusion and exclusion criteria, and the data extraction and quality evaluation were performed for the final inclusion of RCT. Software R 3.3.2 and STATA 14.0 were used for data analysis. Results Fifteen RCTs were included with a total of 1505 children. Network meta-analysis showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were higher than those of desmopressin (complete reaction rate: OR=2.8, 95％ CI :1.5～5.4; success rate: OR=3.5, 95％ CI :1.7～7.5) and alarm (complete response rate: OR=2.7, 95％ CI :1.1～6.6; success rate: OR=3.8, 95％ CI: 1.6～9.0. The success rate of desmopressin combined with alarm was higher than that of alarm (OR=1.9, 95％CI: 1.1～3.4) . The recurrence rate of alarm after treatment was significantly lower than that of desmopressin (OR=0.15, 95％CI: 0.03～0.53) . The ranking results showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were the best. The desmopressin combined with alarm can minimize the number of bed-wetting episodes per week and the recurrence rate of alarm was the lowest among the four regiments. Conclusion The effect of desmopressin combined with anticholinergic drugs is significantly better than that of alarm or desmopressin alone. The combination of desmopressin and alarm has a slight advantage or similar effect to that of single alarm or desmopressin treatment. The effect of desmopressin is similar to that of alarm. Alarm treatment has the lowest recurrence rate.