A case of Hemophagocytic syndrome due to reactivation of Epstein-Barr virus after novel coronavirus infection.

Background: Reactivation of EBV after novel coronavirus infection is common, and co-infection with EBV in patients with novel coronavirus pneumonia may lead to more severe clinical manifestations, prolong the duration of the underlying disease, or precipitate the progression of post novel coronavirus syndrome. EBV-induced hemophagocytic syndrome is a rare and life-threatening condition, and there are no reports of EBV reactivation leading to hemophagocytic syndrome after novel coronavirus infection. Case presentation: Here, we report a case of a 73-year-old man with EBV reactivation after novel coronavirus infection, who was diagnosed with hemophagocytic syndrome after bone marrow aspiration and died after being treated with acyclovir, dexamethasone. Conclusions: the aim of this report is to increase clinical awareness of this type of disease for early recognition and treatment.

Knockdown of P2Y4 ameliorates sepsis-induced acute kidney injury in mice via inhibiting the activation of the NF-κB/MMP8 axis.

Sepsis-induced acute kidney injury (S-AKI) has emerged as a frequent and life-threatening complication in critically ill patients, which is characterized by a systematic inflammatory response and a rapid decline in kidney function. P2Y4, a member of G protein-coupled P2Y nucleotide receptor family, has been reported to serve as a crucial player in inflammatory responses during the development of neurocognitive disorder and myocardial infarction. Nonetheless, the biological role of P2Y4 in S-AKI remains largely unclear. This study aimed to decipher the biological role of P2Y4 in S-AKI and illuminate the potential mechanisms. In this study, S-AKI models were successfully established in mice via cecal ligation and puncture. Results showed that the kidney tissues from S-AKI mouse models exhibited a higher P2Y4 expression level than from the sham-operated group. Knockdown of P2Y4 was found to remarkably alleviate kidney damage and reduce inflammatory response in mice of S-AKI models. Moreover, P2Y4 ablation inhibited the activation of the NF-κB/MMP-8 signaling axis. Additionally, mechanistic studies revealed that rescuing MMP-8 reversed the alleviating effects of P2Y4 knockdown against renal cell damage. Collectively, our findings indicate that P2Y4 knockdown ameliorated S-AKI in mice via inhibiting the activation of the NF-κB/MMP-8 axis and that P2Y4 may represent a novel therapeutic target for S-AKI patients.

Nitric Oxide Mediates Inflammation in Type II Diabetes Mellitus through the PPARγ/eNOS Signaling Pathway.

Inflammation accounts for the process of type II diabetes mellitus (T2DM), the specific mechanism of which is still to be elucidated yet. Nitric oxide (NO), a critical inflammation regulator, the role of which is the inflammation of T2DM, is rarely reported. Therefore, our study is aimed at exploring the effect of NO on the inflammation in T2DM and the corresponding mechanism. We analyzed the NO levels in plasma samples from T2DM patients and paired healthy adults by Nitric Oxide Analyzer then measured the expression of inflammatory cytokines (C-reactive protein, heptoglobin, IL-1ß, TNF-α, IL-6) in insulin-induced HepG2 cells treated with NO donor or NO scavenger, and the PPARγ, eNOS, C-reactive protein, heptoglobin, IL-1ß, TNF-α, and IL-6 levels were detected by RT-PCR and western blot in insulin-induced HepG2 cells transfected with si-PPARγ. The results showed that excess NO increased the inflammation marker levels in T2DM, which is activated by the PPARγ/eNOS pathway. These findings will strengthen the understanding of NO in T2DM and provide a new target for the treatment of T2DM.

A randomized controlled trial study protocol of modified Mahuang-Fuzi-Xixin decoction in the treatment of patients with mild bronchial asthma during acute exacerbation.

INTRODUCTION: These years, due to dissatisfaction with western medicine treatments, traditional Chinese medicine (TCM) becomes a main treatment for bronchial asthma patients. Lung and kidney yang deficiency syndrome is a common type of asthma and the Chinese herbal medicine formula modified Mahuang-Fuzi-Xixin (MFX) decoction is prescribed for mild bronchial asthma patients with acute exacerbation syndrome. However, there is not obvious evidence to support the efficacy and safety of modified MFX decoction the efficacy and safety to treat mild bronchial asthma and the mechanism of this disease is still unclear. METHODS: A double-blind, placebo-controlled, randomized clinical trial was proposed by us. After a 10-day run-in period, 180 eligible objects will be recruited in this study. These subjects will be allocated to the experimental group or control group in a 1:1 ratio. Patients in the experimental group will take modified MFX decoction. At the same time, patients in the control group will receive a matched placebo. The budesonide inhalation powder will be used as a western medicine treatment for both groups. All subjects will receive 14 days of treatment and another 6 months of follow-up. The primary outcome is the mean change in peak expiratory flow rate from the baseline to 14 days in this research. The secondary outcome includes forced expiratory volume in one second, asthma control test score, Asthma Quality of Life Questionnaire score, curative effect of TCM syndrome, and salbutamol dosage. This trial will also explore the association between the change of immunoglobulin E and modified MFX decoction treatment. Any side effects of the treatment will be recorded. DISCUSSION: The results of this trial will provide the evidence for the effect of modified MFX decoction in patients with mild bronchial asthma during acute exacerbation. It also will explore the mechanism of this formula in the treatment of bronchial asthma, which will provide another treatment option for patients with mild bronchial asthma.

Primary pulmonary extranodal NK/T-cell lymphoma of nasal type misdiagnosed as pneumonia: A case report and literature review.

RATIONALE: Primary pulmonary NK/T cell lymphoma is extremely rare, and only a few cases have reported so far. Its diagnosis is mainly dependent on open-lung biopsy. PATIENT CONCERNS: Here, we report a 44-year-old male who was initially misdiagnosed as having pneumonia according to the clinical characteristics and computed tomography (CT) findings. DIAGNOSIS: The first lung biopsy indicated a large number of coagulative necrotic lesions, and definite diagnosis was made after the second lung biopsy following non-response to 6-day wide spectrum antibiotic therapy. The second lung biopsy showed the tumor cells were positive for LCA, CD3ε, CD30, TIA-1, Ki67 and negative for CD20, CD56, CD1a, MPO, CK, S-100, desmin, and CD34. INTERVENTIONS: This patient refused to receive further therapy and died 1 month after confirmed diagnosis. OUTCOMES: Clinically, it is difficult to differentiate pneumonia from NK/T cell lymphoma in pathology due to the presence of plenty of focal necrosis in primary pulmonary NK/T cell lymphoma. LESSONS: The diagnosis of primary pulmonary NK/T cell lymphoma should be based on lung biopsy (usually multiple lung biopsies are required), immunohistochemistry and clinical and imaging findings.