Lessons from Multiple Infections Such as Lymphoma Complicated with Pneumocystis Infection: A Case Report.

Background: Lymphoma is complicated by intricate infections, notably Pneumocystis jirovecii pneumonia (PJP), marked by rapid progression, respiratory failure, and high mortality. Rapid diagnosis of PJP and effective administration of the first-line treatment trimethoprim-sulfamethoxazole (TMP-SMX) are important. For patients intolerant to TMP-SMX, selecting appropriate alternatives is challenging, necessitating careful decisions to optimize diagnosis and treatment. We present a lymphoma case complicated by PJP, illustrating medication adjustment until a positive response was observed. Case Description: A 41-year-old male patient with lymphoma presented with a week-long history of fever, fatigue, cough, sputum, chest tightness, and exertional dyspnea, unresponsive to treatment. Routine laboratory examinations revealed no pathogenic bacteria. PJ and Mycobacterium tuberculosis (MTB) were detected in bronchoalveolar lavage fluid (BALF) using metagenomic next-generation sequencing (mNGS). On Day 1 of admission, meropenem, TMP-SMX, and rifampicin+isoniazid+levofloxacin were administered. However, the patient developed drug-induced hepatotoxicity and gastrointestinal adverse reactions after six days of treatment. After a multidisciplinary team discussion, anti-tuberculosis therapy was stopped because of insufficient evidence of tuberculosis infection. A reduced dose of TMP-SMX with micafungin was used for PJP; however, symptoms persisted and repeated computed tomography showed extensive deterioration of bilateral pulmonary plaques. The PJP regimen was modified to include a combination of TMP-SMX and caspofungin. Due to the high fever and elevated infection indices, the patient was treated with teicoplanin to enhance the anti-infection effects. By Day 13, the patient's temperature had normalized, and infection control was achieved by Day 30. CT revealed that the infection in both lung lobes fully resolved. Subsequently, lymphoma treatment commenced. Conclusion: BALF-NGS facilitates early and rapid diagnosis of PJP. mNGS reads of MTB bacillus <5 may indicate a bacterial carrier state, warranting other detection techniques to support it. There is insufficient evidence for using TMP-SMX with micafungin to treat PJP; however, TMP-SMX combined with caspofungin is suitable.

Overexpression of Annexin A1 protects against benzo[a]pyrene­induced bronchial epithelium injury.

The incidence of asthma is increasing worldwide. Bronchial epithelium injury is common in asthma. The regulatory role of Annexin A1 (ANXA1) in bronchial epithelium injury is currently not well understood. The aim of the present study was to evaluate the role of ANXA1 on bronchial epithelium injury. The cell viability and levels of apoptosis were respectively tested by Cell Counting Kit­8 and flow cytometry. Reactive oxygen species (ROS) content and the activity of oxidative indicators were assessed by commercial kits. Enzyme linked immunosorbent assay was performed to detect the activity of active caspase­3. Reverse transcription­quantitative polymerase chain reaction and western blot assays were used to determine the expression levels of the target factors. The results demonstrated that ANXA1 improved the viability of benzo[a]pyrene (Bap)­treated bronchial epithelial cells. The Bap­induced oxidative stress was mitigated by the reduction in ROS generation, and the regulation of the activity of superoxide dismutase, glutathione peroxidases, malondialdehyde and lactic dehydrogenase. In addition, apoptosis was decreased by ANXA1 via the reduction of the expression of B­cell lymphoma 2 (Bcl­2), and the increase in the expression of Bcl­2­associated X protein and cyclin D1. Furthermore, the expression of phosphatase and tensin homolog (PTEN) and focal adhesion kinase (FAK) was rescued and the phosphorylation of phosphatidylinositol 3­kinase (PI3K)/protein kinase B (Akt) was depressed by ANXA1, when compared with the Bap group. SF1670 treatment reversed the anti­apoptotic effect of ANXA1. In conclusion, the results highlighted the protective effects of ANXA1 on bronchial epithelium injury, which most likely occurred via the PTEN/FAK/PI3K/Akt signaling pathway. Thus, the present study contributes to a potential therapeutic strategy for asthma patients.

[Controlled clinical trials on the treatment of lumbar disk herniation by Dingweiban and Xieban manipulation].

OBJECTIVE: To observe and compare the clinical effect of Dingweiban and Xieban manipulation, and to compare the change of the deviation of spinous processes between two methods. METHODS: One hundred and twenty-two cases were divided into two groups. Sixty-two cases were treated with Dingweiban manipulation method and 60 cases by Xieban manipulation. The changes of Fairbank scores, the clinical effects and the difference of the deviation of the spinous processes (L3, L4, L5) from the lumbar posterior-anterior X-ray were compared. RESULTS: The scores before and after treatment and 3 months after treatment were compared. There were significant differences between two groups (P < 0.05) by nonparametric test. The result of Dingweiban manipulation group: 53 cases cured, 5 cases better, 3 cases effective and 1 case no effect. The result of clinical Xieban manipulation group: 43 cases cured, 6 cases better, 7 cases effective and 4 cases no effect. The clinical effects had significant differences after treatment and 3 months after treatment (P < 0.05, P < 0.0l) by nonparametric test. After the first treating, there was clear difference of the deviations' distance of the L4 spinous process compared with the Xieban manipulation group (P < 0.05). After the last treating, there were clear differences of the deviation distance of the L4 and L5 spinous processes compared with the Xieban manipulation group (P < 0.05, P < 0.01). CONCLUSION: Dingweiban manipulation is better than Xieban manipulation in effects and has influence on the deviation of spinous processes, especially for the L5 spinous process.