[Correlation between traditional Chinese medicine and reduced risk of readmission in rheumatoid arthritis patients with hypoproteinemia:a retrospective cohort study].

This study aimed to explore the correlation between traditional Chinese medicine(TCM) and reduced risk of readmission in patients having rheumatoid arthritis with hypoproteinemia(RA-H). A retrospective cohort study was conducted on 2 437 rheumatoid arthritis patients in the information system database of the First Affiliated Hospital of Anhui University of Chinese Medicine from 2014 to 2021, and 476 of them were found to have hypoproteinemia. The patients were divided into TCM users and non-TCM users by propensity score matching. Exposure was defined as the use of oral Chinese patent medicine or herbal decoction for ≥1 month. Cox regression analysis was performed to explore the risk factors of clinical indicators of rheumatoid arthritis. Additionally, the use of TCM during hospitalization was analyzed, and analysis of association rules was conducted to investigate the correlation between TCM, improvement of indicators and readmission of patients. Kaplan-Meier survival curve was plotted to compare the readmission rate of TCM users and non-TCM users. It was found the readmission rate of RA-H patients was significantly higher than that of RA patients. By propensity score matching, 232 RA-H patients were divided into TCM group(116 cases) and non-TCM group(116 cases). Compared with the conditions in the non-TCM group, the readmission rate of the TCM group was lowered(P<0.01), and the readmission rate of middle-aged and elderly patients was higher than that of young patients(P<0.01). Old age was a risk factor for readmission of RA-H patients, while TCM, albumin(ALB) and total protein(TP) were the protective factors. During hospitalization, the TCMs used for RA-H patients were mainly divided into types of activating blood and resolving stasis, relaxing sinew and dredging collaterals, clearing heat and detoxifying, and invigorating spleen and resolving dampness. The improvement of rheumatoid factor(RF), immunoglobulin G(IgG), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) and ALB was closely related to TCM. On the basis of western medicine treatment, the application of TCM could reduce the readmission rate of RA-H patients, and longer use of TCM indicated lower readmission rate.

Correlation between traditional Chinese medicine and reduced risk of readmission in rheumatoid arthritis patients with hypoproteinemia:a retrospective cohort study / 中国中药杂志

This study aimed to explore the correlation between traditional Chinese medicine(TCM) and reduced risk of readmission in patients having rheumatoid arthritis with hypoproteinemia(RA-H). A retrospective cohort study was conducted on 2 437 rheumatoid arthritis patients in the information system database of the First Affiliated Hospital of Anhui University of Chinese Medicine from 2014 to 2021, and 476 of them were found to have hypoproteinemia. The patients were divided into TCM users and non-TCM users by propensity score matching. Exposure was defined as the use of oral Chinese patent medicine or herbal decoction for ≥1 month. Cox regression analysis was performed to explore the risk factors of clinical indicators of rheumatoid arthritis. Additionally, the use of TCM during hospitalization was analyzed, and analysis of association rules was conducted to investigate the correlation between TCM, improvement of indicators and readmission of patients. Kaplan-Meier survival curve was plotted to compare the readmission rate of TCM users and non-TCM users. It was found the readmission rate of RA-H patients was significantly higher than that of RA patients. By propensity score matching, 232 RA-H patients were divided into TCM group(116 cases) and non-TCM group(116 cases). Compared with the conditions in the non-TCM group, the readmission rate of the TCM group was lowered(P<0.01), and the readmission rate of middle-aged and elderly patients was higher than that of young patients(P<0.01). Old age was a risk factor for readmission of RA-H patients, while TCM, albumin(ALB) and total protein(TP) were the protective factors. During hospitalization, the TCMs used for RA-H patients were mainly divided into types of activating blood and resolving stasis, relaxing sinew and dredging collaterals, clearing heat and detoxifying, and invigorating spleen and resolving dampness. The improvement of rheumatoid factor(RF), immunoglobulin G(IgG), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) and ALB was closely related to TCM. On the basis of western medicine treatment, the application of TCM could reduce the readmission rate of RA-H patients, and longer use of TCM indicated lower readmission rate.

Epidemiological, clinical, and laboratory features of patients infected with Elizabethkingia meningoseptica at a tertiary hospital in Hefei City, China.

Background: Elizabethkingia meningoseptica is a bacterium causing potential nosocomial infections and is associated with a high mortality rate; however, the date of patients in the Hefei population who have been diagnosed with this infection is generally limited. Purpose: The clinical and laboratory data of patients from a tertiary hospital in Hefei City who had E. meningoseptica infection were evaluated in this retrospective analysis. Patients and methods: From May 2017 to November 2021, there were 24 patients infected with E. meningoseptica in the First Affiliated Hospital of Anhui Medical University. Data were gathered from the hospital's electronic medical records for all patients. Results: The most prevalent symptom among the 24 patients was fever (83.3%), followed by edema (41.7%), cough (37.5%), altered consciousness (41.7%), and sputum (37.5%), and laboratory results presented with anemia (75%), hypoproteinemia (75%), elevated C-reactive protein (CRP) (66.7%), neutrophilia (54.2%), and leukocytosis (50.0%). Hepatic disease (1 vs. 7, P = 0.009) was the only significant risk factor for underlying diseases. The mean value of lymphocyte (LYMPH#) (1.4 vs. 0.83 × 109/L, P = 0.033) counts was higher in the survival group than death group, while both anemia (8 vs. 10, P = 0.024) and hypoproteinemia (8 vs. 10, P = 0.024) occurred more frequently in the death group compared with the survival one. Conclusion: Fever was the most common symptom and the only significant factor of underlying diseases was hepatic disease (P = 0.009) that often occurred in death groups. In this investigation, the risk factors for death in patients were anemia, hypoproteinemia, and lymphocyte count. The susceptibility of some quinolones, piperacillin-tazobactam, and cotrimoxazole was relatively high, suggesting that they may be the preferred drugs for the treatment of E. meningoseptica infection. As E. meningoseptica can produce biofilm to pollute the hospital environment and cause infection in patients, the disinfection of the hospital environment should be strengthened and medical staff should pay attention to aseptic operations.

Development and validation of nomograms for predicting the risk probability of carbapenem resistance and 28-day all-cause mortality in gram-negative bacteremia among patients with hematological diseases.

Objectives: Gram-negative bacteria (GNB) bloodstream infections (BSIs) are the most widespread and serious complications in hospitalized patients with hematological diseases. The emergence and prevalence of carbapenem-resistant (CR) pathogens has developed into a considerable challenge in clinical practice. Currently, nomograms have been extensively applied in the field of medicine to facilitate clinical diagnosis and treatment. The purpose of this study was to explore risk indicators predicting mortality and carbapenem resistance in hematological (HM) patients with GNB BSI and to construct two nomograms to achieve personalized prediction. Methods: A single-center retrospective case-control study enrolled 244 hospitalized HM patients with GNB-BSI from January 2015 to December 2019. The least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis were conducted to select potential characteristic predictors of plotting nomograms. Subsequently, to evaluate the prediction performance of the models, the prediction models were internally validated using the bootstrap approach (resampling = 1000) and 10-fold cross validation. Results: Of all 244 eligible patients with BSI attributed to GNB in this study, 77 (31.6%) were resistant to carbapenems. The rate of carbapenem resistance exhibited a growing tendency year by year, from 20.4% in 2015 to 42.6% in 2019 (p = 0.004). The carbapenem resistance nomogram constructed with the parameters of hypoproteinemia, duration of neutropenia ≥ 6 days, previous exposure to carbapenems, and previous exposure to cephalosporin/ß-lactamase inhibitors indicated a favorable discrimination ability with a modified concordance index (C-index) of 0.788 and 0.781 in both the bootstrapping and 10-fold cross validation procedures. The 28-day all-cause mortality was 28.3% (68/240). The prognosis nomogram plotted with the variables of hypoproteinemia, septic shock, isolation of CR-GNB, and the incomplete remission status of underlying diseases showed a superior discriminative ability of poorer clinical prognosis. The modified C-index of the prognosis nomogram was 0.873 with bootstrapping and 0.887 with 10-fold cross validation. The decision curve analysis (DCA) for two nomogram models both demonstrated better clinical practicality. Conclusions: For clinicians, nomogram models were effective individualized risk prediction tools to facilitate the early identification of HM patients with GNB BSI at high risk of mortality and carbapenem resistance.

Broadly effective metabolic and immune recovery with C5 inhibition in CHAPLE disease.

Complement hyperactivation, angiopathic thrombosis and protein-losing enteropathy (CHAPLE disease) is a lethal disease caused by genetic loss of the complement regulatory protein CD55, leading to overactivation of complement and innate immunity together with immunodeficiency due to immunoglobulin wasting in the intestine. We report in vivo human data accumulated using the complement C5 inhibitor eculizumab for the medical treatment of patients with CHAPLE disease. We observed cessation of gastrointestinal pathology together with restoration of normal immunity and metabolism. We found that patients rapidly renormalized immunoglobulin concentrations and other serum proteins as revealed by aptamer profiling, re-established a healthy gut microbiome, discontinued immunoglobulin replacement and other treatments and exhibited catch-up growth. Thus, we show that blockade of C5 by eculizumab effectively re-establishes regulation of the innate immune complement system to substantially reduce the pathophysiological manifestations of CD55 deficiency in humans.

Collagenous gastritis: An unusual cause of generalized oedema in a child.

Collagenous gastritis is an uncommon gastrointestinal disease in children. Its cause remains uncertain. It may present as severe hypoproteinaemia manifesting as generalized oedema. We report a 15 months old female who presented with pica, generalized body oedema and diarrhoea. Diagnostic workup revealed gastric replacement of the lamina propria by hyalinized collagen on histology. This case seeks to highlight the need for early paediatric gastroenterology referral including oesophagogastroduodenoscopy with multiple tissue biopsies as part of a broad diagnostic workup in children with non-specific gastrointestinal symptoms to improve diagnostic yield and enable accurate histologic diagnosis, so that appropriate therapy can be timeously applied.

[A Case of Huge Colon Cancer Accompanied with Severe Hypoproteinemia].

We report a case of huge colon cancer accompanied with severe hypoproteinemia. A7 4-year-old woman was referred to our hospital because of abdominal fullness. Blood examinations revealed anemia(hemoglobin 8.8 g/dL)and sever hypopro- teinemia(total protein 4.5 g/dL, albumin 1.1 g/dL). Computed tomography examination of abdomen revealed ascites and large tumor(12.5×10.5 cm)at the right side colon. By further examinations ascending colon cancer without distant metastasis was diagnosed, then we performed right hemicolectomy and primary intestinal anastomosis by open surgery. Ahuge type 1 tumor(18×12 cm)was observed in the excised specimen, which invaded to terminal ileum directly. The tumor was diagnosed moderately differentiated adenocarcinoma without lymph node metastasis(pT3N0M0, fStage II ). Postoperative course was uneventful and serum protein concentration recovered gradually to normal range. Protein leakage from the tumor cannot be proved by this case, so we can't diagnose as protein-losing enteropathy, but we strongly doubt this etiology from postoperative course in this case.

Pregnant Woman Bitten by a Japanese Mamushi (Gloydius blomhoffii).

We herein report the fourth case of a pregnant woman bitten by a mamushi. A 33-year-old pregnant woman in the 25th week of gestation was bitten by a mamushi. Her vital signs were stable; however, biochemical analyses of the blood showed mild deterioration of anemia and hypoproteinemia. The effects of envenomation were limited to the extremities, the administration of supportive therapy without antivenom fortunately resulted in a favorable outcome. As there are differences in the maternal medical condition and weeks of gestation, further research is needed to clarify the optimal management strategy for administering antivenom in pregnancy.

[Pathogenetic grounds of trophological impact of chronic pancreatitis complex therapy].

In chronic pancreatitis patients was found persistent state of oxidative stress on the level of malonic aldehyde, which ran against the lowered levels of antioxidant enzymatic and non-enzymatic composition, and it has been found in the state of hypoproteinemia proteinogram indices (P < 0.05). The use of complex treatment of patients with chronic pancreatitis multivitamin-aminoacid drug Moriamin forte contributes to a significant regression effects oxidative stress and reduces the effects of hypoproteinemia (P < 0.05).

Cap-polyposis-like gastropathy with hypoproteinemia treated with H. pylori eradication.

We herein report the case of a 43-year-old man with distinct gastropathy and hypoproteinemia treated with H. pylori eradication therapy. Most reported cases of protein-losing gastropathy are divided into Ménétrier's disease (MD) and diffuse varioliform gastritis (DVG). Our patient presented with leg edema due to marked hypoalbuminemia, which we ascribed to distinct gastropathy with novel endoscopic findings resembling cap polyposis in the colon, apparently different from both MD and DVG. H. pylori eradication therapy promptly induced the normalization of laboratory data and mucosal healing. Our case together with two previously published similar cases may contribute to establishing an association between cap-polyposis-like-gastropathy with hypoproteinemia and H. pylori.

Synchronous triple cancers of the pancreas, stomach, and cecum treated with S-1 followed by pancrelipase treatment of pancreatic exocrine insufficiency.

CONTEXT: Pancreatic cancer is frequently complicated by malignancies in other organs. However, synchronous triple cancers including pancreatic cancer have been seldom reported in the English language literature. CASE REPORT: We describe the rare case of a 77-year-old man with triple cancers of the pancreas, stomach, and cecum. Biopsies revealed that all three tumors were adenocarcinomas. The pancreatic and gastric tumors were positive for cytokeratin 7 and negative for cytokeratin 20, whereas the cecal tumor was negative for cytokeratin 7 and positive for cytokeratin 20. K-ras mutations were present at codon 12 in the pancreatic tumor and at codon 13 in the cecal tumor, but were absent from the gastric tumor. Since the three tumors had different characteristics, the patient was diagnosed with synchronous triple cancers. Because invasive surgery was required to remove all three tumors and the patient had risk factors for surgery, we elected to treat him with chemotherapy. All three cancers were markedly reduced in size by treatment with cycles of 100 mg/day S-1 for 2 weeks, followed by a 1-week rest. The patient later developed hypoproteinemia and anasarca, which was diagnosed as pancreatic exocrine insufficiency due to pancreatic head cancer. Treatment with pancrelipase resulted in dramatic improvements in hypoproteinemia and anasarca. CONCLUSIONS: This is the first case report in which S-1 was effective in triple cancers of the pancreas, stomach, and cecum. Patients with pancreatic head cancer should be monitored for pancreatic exocrine insufficiency.

How to optimise antimicrobial prescriptions in the Intensive Care Unit: principles of individualised dosing using pharmacokinetics and pharmacodynamics.

Optimising antimicrobial dosing for critically ill patients is highly challenging and when it is not achieved can lead to worse patient outcomes. To this end, use of dosing regimens recommended in package inserts from drug manufacturers is frequently insufficient to guide dosing in these patients appropriately. Whilst the effect of critical illness pathophysiology on the pharmacokinetic (PK) behaviour of antimicrobials can be profound, the variability of these changes between patients is still being quantified. The PK effects of hypoproteinaemia, organ dysfunction and the presence of augmented renal clearance may lead to plasma antimicrobial concentrations that are difficult to predict at the bedside, which may result in excess toxicity or suboptimal bacterial killing. This paper outlines the factors that affect pharmacokinetics in critically ill patients and how knowledge of these factors can increase the likelihood of achieving optimal antimicrobial plasma concentrations. In selected settings, we advocate individualised dosing of renally cleared antimicrobials using physiological data such as measured creatinine clearance and published non-renal clearance data. Where such data do not exist, therapeutic drug monitoring may be a useful alternative and has been associated with significant clinical benefits, although it is not currently widely available.

Effect of ascorbic acid, alpha-tocopherol, lecithin and L-ornithine-L-aspartate on ethanol induced hypoproteinemia and hyperlipidemia in rats.

We studied effect of exogenous ascorbic acid, alpha-tocopherol, lecithin and L-ornithine-L-aspartate on serum lipids and proteins in experimental hepatotoxic Wistar rats. Eleven groups (n = 6) of animals were used. Hepatotoxicity was induced by administering ethanol (1.6 g/kg/day) for 28 days. Both preventive and curative options were studied. Percentage increase in body weight was significantly lower in ethanol treated rats. Ethanol significantly (P<0.05) increased cholesterol, triglycerides and LDL, and decreased protein, albumin and A:G ratio in serum. Ascorbic acid, alpha-tocopherol, lecithin and L-ornithine-L-aspartate exhibited an ability to counteract the alcohol-induced changes in the body weight and biochemical parameters in preventive and therapeutic models in varying degree. Antioxidants showed better effect.

A combination therapy with copper nicotinate complex reduces the adverse effects of 5-fluorouracil on patients with hepatocellular carcinoma.

5-Fluorouracil (5-FU) as chemotherapy in cases of hepatocellular carcinoma (HCC), was found to initiate hepatotoxic injuries, ascites, leucopenia, thrombocytopenia and myelosupression that limit its use. Therefore, this work was conducted to investigate whether the combination of copper (I)-nicotinate complex [CuCl (HNA)2] with 5-FU may overcome such a drug resistance. Forty-eight patients with HCC were therapy-naïve and treated with 5-FU (12 mg/kg/day) for 5 days in 2 cycles with 4 weeks in between. Twenty-four of them were simultaneously given oral doses of copper (I)-nicotinate complex (0.8 mg/kg/day) started with the 5-FU treatment. The combined therapy of CuCl (HNA)2 with 5-FU could improve the prognosis of HCC-patients. Improvement of liver function was presented by significant reduction of serum bilirubin (p<0.001), transaminases and alkaline phoshatase (p<0.05). The copper complex prevented hypoproteinaemic and hypoalbuminaemic effects of 5-FU and rendered the prothrombin time to its normal value (p<0.001). Superoxide dismutase, ceruloplasmin and immunoglobulins IgG showed significant increases (p<0.001), while serum copper and lipid peroxides were reduced (p<0.001). Thrombocytopenia, leucopenia and other myelosuppressive effects of 5-FU were reduced by the co-administration of CuCl (HNA)2. In conclusion the combination with CuCl (HNA)2 given in such a dosage schedule mitigated the most frequent toxicities associating 5-FU administration and enhanced defense mechanisms against oxidative stress.

[Pre-operation application of recombinant human growth hormone for liver cirrhosis with portal hypertension and hypoproteinemia].

OBJECTIVE: To evaluate the effectiveness of pre-operation use of recombinant human growth Sixty patients with hormone (rhGH) for liver cirrhosis with portal hypertension and hypoproteinemia. METHODS: Sixty patients with liver cirrhosis and portal hypertension and hypoproteinemia (child's class B) were randomly divided into control group (n = 30) and rhGH group (n = 30). The patients in the rhGH group were given subcutaneously growth hormone at a dose of 4 i.u. per day for five days before operation. All patients were given the same parenteral nutrition before operation. The levels of albumin, globulin, prealbumin, and blood sugar were measured before and 3, 4, and 5 days after given the hormone. Results The prealbumin increased 3 days after given the hormone (P < 0.05), while the albumin increased 5 days after given the hormone (P < 0.05). The general condition and the quality of life of the patients receiving the hormone improved. No side effects had been found. The blood sugar and globulin did not change over time in both groups. CONCLUSION: The pre-operation use of the recombinant human growth hormone may benefit to the alleviation of hypoproteinemia and to the improvement of the quality of life of the patients with liver cirrhosis and portal hypertension and hypoproteinemia when combined with the use of parenteral nutrition.

A case of toxic shock-like syndrome presenting with serious hypoproteinaemia because of a protein-losing gastroenteropathy.

A 37-year-old man was admitted to our hospital because of toxic shock-like syndrome (TSLS) induced by Streptococcus pyogenes. After the pathogenic bacteria had been eradicated, serious diarrhoea appeared and a protein-losing gastroenteropathy developed. An immunohistochemical study of the biopsy specimens of both small and large intestines revealed the infiltration of T-lymphocytes, predominantly CD8+ cells, into the lamina propria of affected mucosa, villus atrophy and crypt hyperplasia. Considering these histological findings, some immunological mechanism which lead the activation of cytotoxic T-lymphocytes may play an important role in the pathogenesis of this rare intestinal manifestation of TSLS.

Inhibitory effect of resveratrol on proteinuria, hypoalbuminemia and hyperlipidemia in nephritic rats.

The effect of resveratrol, a polyphenolic compound present in grapes and other plants, on proteinuria, hypoalbuminemia and hyperlipidemia was studied in rats with glomerulonephritis. The nephritis was induced by an intravenous injection of anti-rat kidney glomerular basement membrane rabbit antiserum. Nephritic rats were given oral intubation of resveratrol (5 mg/day/100 g body weight) for 14 days, while control nephritic rats as well as normal ones were similarly given vehicle alone. By resveratrol treatment, enlargement in liver and kidney due to nephritis induction was significantly reduced, together with partial restoration of nephritis-induced reduction in body weight gain. Both proteinuria and hypoalbuminemia, characteristic symptoms to nephrotic syndrome, were significantly remedied, that is, urinary protein excretion was suppressed and serum albumin concentration was increased by resveratrol treatment. Resveratrol also suppressed significantly hyperlipidemia incident to nephritis, the hypotriglyceridemic action being more prominent than the hypocholesterolemic one. From these results, resveratrol is suggested to be a potent anti-glomerulonephritic food factor capable of suppressing proteinuria, hypoalbuminemia and hyperlipidemia at the same time.

[Albumin--biological functions and clinical significance]. / Albumina--funkcje biologiczne i znaczenie kliniczne.

Albumin is a simple protein present both in animal and plant physiological fluids and tissues. It plays many important roles including maintenance of appropriate osmotic pressure, binding and transport of various substances like hormones, drugs etc. in blood, and neutralisation of free radicals. Both acute and chronic disorders lead to hypoalbuminemia, oedema and many other disturbances. Albumin preparations obtained by separation of human plasma are used clinically for more than 50 years to reverse hypoalbuminemia and to allow for reversal of abnormalities in substance transport. These problems are discussed through out this paper.