[COVID-19 in patients with Good syndrome: report of 4 cases and literature review].

Objective: To summarize the clinical characteristics of coronavirus disease 2019 (COVID-19) in patients with Good's syndrome. Methods: We included all cases of COVID-19 in patients with Good's syndrome in the Second Xiangya Hospital of Central South University from January 1, 2023 to August 31, 2023. In addition to our cases, we searched the published literature in Wanfang database and PubMed database using the keywords "Good's syndrome" and "COVID-19". The clinical characteristics, treatment and outcome of the patients were summarized and analyzed. Results: A total of four patients with Good's syndrome complicated by COVID-19 were identified in our hospital, all of them were male, and the days of hospitalization were 17, 23, 7, and 13 days, respectively. Databases were searched for a total of six patients with Good's syndrome complicated by COVID-19, including three females and three males, all foreign patients, with hospitalization days of 12, 22, 13, 25, 21, and 34 days respectively. All ten patients met the diagnostic criteria for severe or critical COVID-19, and three(all middle-aged males) of them died, two from sepsis and one from respiratory failure. They were. Conclusion: COVID-19 in patients with Good's syndrome are prone to develop severe or critical disease and are more likely to be infected with multiple pathogens. Timely immunoglobulin supplementation is the key to treatment.

[Epidemiological characteristics of imported malaria cases in Fujian Province from 2014 to 2018].

OBJECTIVE: To analyze the epidemiological characteristics of imported malaria cases in Fujian Province from 2014 to 2018, so as to provide scientific basis for the development of the control strategy for imported malaria. METHODS: The epidemiological data of malaria cases in Fujian Province from 2014 to 2018 were retrieved from the Notifiable Disease Reporting System and Parasitic Disease Information Reporting System of Chinese Center for Disease Control and Prevention, and the classification, origin of infections, temporal distribution, spatial distribution, population distribution, reporting institutions and diagnosis were analyzed. RESULTS: A total of 540 overseas imported malaria cases were reported in Fujian Province from 2014 to 2018, and all cases were laboratory-confirmed, including 398 cases with falciparum malaria, 88 cases with vivax malaria, 38 cases with ovale malaria, 14 cases with malariae malaria and 2 cases with mixed infections. There were 90.56% (489/540) of the imported malaria cases with infections in 27 African countries, 5.92% (32/540) with infections in 5 Asian countries and 3.52% (19/540) with infections in one Oceania country. There was no significant seasonal distribution of the cases, and the imported malaria cases were predominantly detected in Fuzhou City (80.00%, 432/540) and at ages of 20 to 49 years (81.48%, 440/540). Initial diagnosis was predominantly at the city-level medical institutions, and 77.96% (421/540) were diagnosed as malaria at the initial diagnosis institutions. The median duration from onset to initial diagnosis was 2 days and 70.19% (379/540) were diagnosed within 3 days of onset. The interval between initial diagnosis and definitive diagnosis was 0 day, with 85.37% (461/540) definitively diagnosed within 3 days of initial diagnosis. CONCLUSIONS: Overseas imported malaria is a continuous problem challenging the malaria elimination programme of Fujian Province. Improving the healthcare-seeking awareness and the diagnostic capability of healthcare workers, and intensifying the monitoring and management of malaria among overseas labors are strongly recommended.

[Repair of complex wounds on hands after burns or trauma].

Objective: To explore the repair methods and effects of the complex wounds on hands after burns or trauma. Methods: From January 2008 to December 2017, 45 patients (28 males and 17 females, aging 8 to 58 years) with severe hand injuries after burns or trauma combined with deep tissue exposure were admitted to our hospital. Two patients had whole-fingers degloving injuries, 27 patients had dorsal hand injuries, and 16 patients had palmar injuries. After debridement, the area of soft tissue defects was 7 cm×6 cm to 19 cm×12 cm combined with 0.5 cm×0.4 cm to 10.0 cm×4.0 cm of single deep tissue exposure. Different repairing methods were adopted according to the area and location of deep tissue exposure. Five patients with small area exposure were treated with artificial dermis+ vacuum sealing drainage (VSD)+ autogenous skin grafting. Thirty-eight patients with unilateral large area exposure on palm or dorsum were treated with segmented ligation of abdominal thin flaps (with area of 8 cm×7 cm to 15 cm×9 cm). Two patients with bilateral large area exposure in dorsal and palmar hands were treated with modified abdominal bag-shaped delayed thin flaps (with area of 12 cm×5 cm to 12 cm×9 cm and 12 cm×6 cm to 14 cm×9 cm). The donor sites were directly sutured or repaired with intermediate split-thickness skin or adjacent flap. The survival of grafts and flaps was observed, number of operations, wound healing time, and follow-up were recorded. Results: (1) Among the patients receiving artificial dermis+ VSD+ autogenous skin grafting, the wounds of 3 patients were healed after 2 operations, and 2 patients had artificial dermis infection and lysis, and tendon necrosis, which were healed after 3 operations. The wound healing time of 5 patients was 14 to 33 days post injury. During the follow-up of 3 months, the affected hands were in good shape with soft texture and fewer scars, and functional evaluation of hand was good in 3 cases and modest in 2 cases. (2) The patients receiving segmented ligation of abdominal thin flaps all underwent 2 operations without flap necrosis. The wound healing time was 2 to 3 weeks post injury. Thirty-five patients underwent one to six-years' follow-up, which showed that the flaps were in good shape and color with soft texture, and the functional evaluation of hand was excellent in 25 cases, good in 7 cases, and modest in 3 cases. Three patients were lost to follow-up. (3) In the 2 patients receiving modified abdominal bag-shaped delayed thin flaps, all flaps survived after 5 operations, the wounds were healed on post injury day 22 and 24 respectively, the shape and texture of the affected hands was good with no bloated appearance after separating fingers and revision. During the follow-up of 2 years, the functional evaluation of hand was good in 2 cases. Conclusions: For the complex wounds on hands after burns or trauma, if the area of deep tissue exposure is small, artificial dermis+ VSD+ autogenous skin grafting should be adopted, which has good effects. If the area of unilateral deep tissue exposure is large, segmented ligation of abdominal thin flap should be adopted; if the area of bilateral deep tissue exposure is large, modified abdominal bag-shaped delayed thin flap should be adopted. These methods can reduce the number of operations, shorten wound healing time, and obtain good shape and function of hands.

[One case of patient with bilateral ectopic subclavian vein catheterization].

One female patient aged 18 years, with severe burns and inhalation injury was admitted to our unit on June 5th, 2013. After admission, the right subclavian vein catheterization was performed for rapid fluid infusion against shock. Escharectomy on both upper extremities was planned to carry out and repaired with medium-thickness skin on right thigh 52 hours after injury. However, after general anesthesia, the right subclavian vein catheter was with poor fluid infusion, and the left subclavian vein catheterization was performed. Supraventricular tachycardia and decreased blood pressure occurred followed by fluid replacement and dilatation, cardiotonics, and diuretics. Postanesthetic 1.3 hours, the patient's vital signs were stable, and the operation began. Postoperative chest X-ray film showed that distal ends of the left and right subclavian vein catheters were respectively located in the right atrium and the right internal carotid vein, and the catheters were removed immediately. This case suggests that clinical physician should be careful to prevent catheter heterotopia in subclavian vein catheterization, and postoperative routine chest X-ray examination is necessary to identify position of the catheter.

Epigenetic mechanisms in chronic obstructive pulmonary disease.

Epigenetic modification may affect the expression of multiple inflammatory genes in lungs of patients with chronic obstructive pulmonary disease (COPD). Major epigenetic events include DNA methylation and various post-translational modifications of histones, such as histone methylation, acetylation, phosphorylation, ubiquitination, and sumoylation. Enzymes which regulate these epigenetic modifications can be activated by smoking. Both environmental and genetic factors play significant effect in development of COPD which have been reported by most references; however, little is known about the epigenetic pathways involved in the disease. Understanding the epigenetic mechanisms can help us clarify the pathogenesis of COPD and identify novel targets for developing new therapies for patients with COPD.

The presence of atypical small acinar proliferation in prostate needle biopsy is predictive of carcinoma on subsequent biopsy.

OBJECTIVE: To determine the clinical significance of nondiagnostic small acini showing cellular atypia (atypical small acinar proliferation) in prostatic biopsies of patients with clinical findings suggestive of malignancy. PATIENTS AND METHODS: Of 331 patients who underwent thin-core biopsy of the prostate over a 30-month period, 21 (6.3%) had atypical histological features, and of these 17 underwent repeat biopsy. In addition, a further 20 patients with normal histology underwent repeat biopsy for persistent abnormal clinical findings. The incidence and Gleason score of carcinomas subsequently diagnosed in the two groups were compared. The predictive significance of patient age, prostate specific antigen (PSA) level and digital rectal examination (DRE) findings were compared between both patient groups, those in each group subsequently found to have carcinoma, and between patients with malignant or normal repeat biopsies who had either atypical or normal initial biopsies. RESULTS: Nine patients with atypical histology and four with normal histology on initial biopsy were found to have carcinoma on subsequent biopsy (P = 0.036). The site of carcinoma diagnosed in the repeat biopsy frequently differed from that of the initial atypical biopsy. The Gleason primary pattern was not significantly different between the groups. Neither patient age, PSA level nor DRE findings differed between patients with initial normal or atypical biopsy, or in these groups for those in whom carcinoma was subsequently diagnosed. These clinical features did not distinguish between those with carcinoma or normal findings on repeat biopsy who had an initial atypical biopsy, while only PSA level varied significantly in patients with normal or malignant repeat biopsy in the group with an initial normal biopsy. CONCLUSION: The presence of atypia on initial biopsy is a strong predictor of malignancy in subsequent biopsy specimens.

[Altered subcellular distribution of daunorubicin in the non-P-glycoprotein-mediated multidrug-resistant cell line HL-60/ADR].

OBJECTIVE: To investigate DNR subcellular distribution in the non-P-glycoprotein-mediated multidrug-resistant cell line HL-60/ADR and its relation to multidrug resistance. METHODS: DNR subcellular disposition was studied by confocal scanning laser microscopy, fluorescent methods, MTT and RT-PCR. The effects of verapamil, brefeldin A, chloroquine were also examined. RESULTS: In the drug-sensitive cell line HL-60 DNR fluorescence distributed evenly in the nucleus and cytoplasm, while in the resistant cell line DNR distributed in a punctate pattern in the cytoplasm and was reduced in the nucleus. Verapamil, brefeldin A, but not chloroquine could recover the intracellular distribution of DNR from punctate to even in the resistant cell line. CONCLUSION: Altered subcellular disposition of DNR in resistant cell line was involved in the mechanism of multidrug resistance.

[Clinical study of inhaled corticosteroid in non-asthmatic chronic obstructive pulmonary disease].

OBJECTIVE: There is less unanimity about the effects of inhaled corticosteroid in patients with non-asthmatic chronic obstructive pulmonary disease(COPD). The aim of this study is to determine whether patients with non-asthmatic COPD have favorable responses to inhaled corticosteroid (ICS). METHOD: A randomized, placebo-controlled, single-blind trial of inhaled beclomethasone dipropionate(BDP 1000 micrograms daily for 6 weeks) was carried out in 61 patients with stable non-asthmatic COPD. Before and after the therapy, the scores of clinical symptoms and the scores of quality of life were recorded, and the pulmonary function and plasma level of endothelin-1 (ET-1) were measured. RESULT: 58 patients finished the study. Compared with the placebo-group, after receiving 6 weeks of ICS therapy, the BDP group showed significant improvement in clinical symptoms (P < 0.05), but not in the quality of life (P > 0.05). There was also an improvement in FEV1(P < 0.001), but not in MMEF (P > 0.05). The plasma concentration of ET-1 was not changed significantly in both groups. CONCLUSION: The study suggested that the therapy of ICS (1000 micrograms daily for 6 weeks) can improve clinical symptoms and pulmonary function in patients with stable non-asthmatic COPD, but cannot affect the quality of life and the plasma concentration of ET-1.

Treatment of acute promyelocytic leukemia with all-trans retinoic acid. A five-year experience.

From January 1986 to April 1991, 107 consecutive patients with acute promyelocytic leukemia (APL) were treated with retinoic acid (RA) at an oral dose of 45-60mg/m2/d, alone or in combination with chemotherapy. In 91 cases treated with RA alone, 74 (81.3%) achieved complete remission (CR). The CR rate was 75% in 16 cases treated with combined therapy. Among 50 patients closely followed for a median of 36 months (4-60), 10 received RA as continuation therapy (Group A), 10 received chemotherapy (Group B) and 30 were treated with RA and chemotherapy alternately in regular sequence (Group C). The mean survival time was 8.4, 9.7 and 21.6 months, respectively, for the 29 cases who died. The survival probability was higher in Group C than in Group A and B (P < 0.01). RA did not provoke or aggravate DIC, it did not cause marrow hypoplasia or aplasia. The side effects were relatively mild as compared with chemotherapy. CFU-GM markedly reduced before treatment was restored to normal level after CR, while the result for L-CFU was reversed. In 40 cases examined for in vitro induction of differentiation, 39 responders were culminating in CR. Aberrant karyotype t (15; 17) was positive in all 47 cases examined prior to the treatment. It disappeared in all of the 20 cases studied after achieving CR, and reappeared in 3 cases following relapse. The best regimen to maintain a longer CR duration and survival time in this study was to use RA and chemotherapy alternately as continuation therapy.

Problems existing in differentiation therapy of acute promyelocytic leukemia (APL) with all-trans retinoic acid (ATRA).

A large number of acute promyelocytic leukemia (APL) patients, treated with all-trans retinoic acid (ATRA) and chemotherapy, were studied. The results of the studies are as follows: (1) Among 65 patients investigated for the postremissional therapy, the 5-year survival probabilities were 0.20 +/- 0.13 (mean +/- SE) in the group treated with ATRA alone, 0.47 + 0.10 (mean +/- SE) in the group using chemotherapy alone and 0.42 +/- 0.09 (mean +/- SE) in the group treated with chemotherapy and ATRA. (2) The main severe adverse effects in the ATRA treatment include retinoic acid syndrome, renal failure, and thrombosis. These sequelae were observed more frequently in cases with persistent, marked elevation of white blood cell count without significant maturation of leukemic promyelocytes. (3) APL is not a homogeneous disease in that among 50 patients studied at the molecular level, although a PML-RARA fusion gene was detected in 45 cases, one had a variant translocation t(11;17) bearing fusion gene PLZF-RARA, one presented no obvious structural alteration of the PML gene while the RARA gene was rearranged, and three patients had no rearrangement of either PML or RARA genes. (4) Using RT/PCR to detect minimal residual disease, we found positive rates of 22%, 18.4%, and 11.5%, respectively, 12, 24, and 36 months after CR. This observation justifies the use of chemotherapy for at least 3 years after CR induced by ATRA. (5) It seems likely that the fusion gene PML-RARA plays an important role in APL leukemogenesis and in its response to the ATRA treatment.