AIDS complicated with plasmablastic lymphoma: Clinical analysis of 7 cases / 中华临床感染病杂志

Objective:To analyze the clinical characteristics of AIDS complicated with plasmablastic lymphoma (PBL).Methods:Clinical data and laboratory test of 7 AIDS patients complicated with PBL admitted to Yunnan Infectious Disease Hospital from January 2016 to October 2022 were retrospectively analyzed.Results:There were 6 male patients and 1 female patient with a median age of 48 years (41-56 years). All patients had oral and maxillofacial involvement, and only 1 case was stage Ⅱ at the initial Ann Arbor stage, while 6 cases were stage Ⅲ or higher. Six patients had systemic symptoms. All patients had a Ki-67 proliferation index greater than 80% and all presented MYC gene rearrangements, and 6 patients were positive for EBER. All patients received DA-EPOCH-based first-line chemotherapy and antiretroviral therapy (ART), Five patients initiated ART at the same time as chemotherapy, and 2 patients initiated ART before chemotherapy. Four patients achieved complete remission after chemotherapy according to PET-CT evaluation, and 3 patients died.Conclusions:Active chemotherapy combined with ART can maximize the therapeutic benefits of AIDS patients with PBL. The introduction of ART in the first chemotherapy cycle can avoid the rapid disease deterioration in the patients.

Clinical characteristics of eight human immunodeficiency virus positive patients with systemic lupus erythematosus / 中华传染病杂志

Objective:To analyze the clinical characteristics, diagnosis and treatment process, and prognosis of human immunodeficiency virus (HIV) positive patients with systemic lupus erythematosus (SLE).Methods:A retrospective study was used to collect and analyze the clinical characteristics, treatment and prognosis of eight HIV-positive patients with SLE treated in Yunnan Provincial Infectious Diseases Hospital from August 2017 to January 2020.Results:All of the eight patients were diagnosed with SLE after HIV infection. All of the patients were female. CD4 + T lymphocyte counts were >500/μL in four cases, 350 to 499/μL in two cases, and 200 to 349/μL in the remaining two cases. Case 6 presented with butterfly erythema on the face. In Case 1, hemoglobin was 40 g/L and urine occult blood was (+ + ). The hemoglobin of Case 2 was 76 g/L, the platelet count was 2×10 9/L, and the granulocyte count was 0.6×10 9/L. The lung computed tomography (CT) examination of Case 3 showed diffuse exudative lesions in both lungs. The 24 h urinary protein levels of Case 4 and 5 were 2 231.6 mg and 2 761.0 mg, respectively, and urine occult blood were (+ + ). The total bilirubin of Case 4 was 70.0 μmol/L and alanine aminotransferase (ALT) was 49 U/L. The total bilirubin of Case 7 was 129.6 μmol/L and ALT was 56 U/L. The lung CT examination of Case 8 showed moderate to massive pericardial effusion in the pericardium. Seven patients received antiviral therapy and immunotherapy, and their conditions were stable without relapse. Case 1 was refractory SLE complicated with autoimmune hemolytic anemia. After treated with rituximab combined with cyclophosphamide the patient achieved clinical remission. Case 7 was injection drug user and died after giving up treatment. Conclusions:The clinical characteristics of HIV-positive patients with SLE are heterogeneous, and the prognosis is generally good after antiviral therapy and immunotherapy. For patients with refractory SLE complicated with autoimmune hemolytic anemia, clinical remission can also be achieved through active treatment.

The value of muscle biopsy in rhabdomyolysis / 中华内科杂志

Objective@#To analyze the diagnostic value of skeletal muscle biopsy in patients with rhabdomyolysis.@*Methods@#Clinical and pathological data of 26 patients with rhabdomyolysis from January 2002 to December 2018 undergoing muscle biopsy were collected.@*Results@#Eighteen males and 8 females were finally recruited with median age of 6-73 (37.3±19.6) years. The average time from onset to biopsy was 44 days (median course was 30 days). All patients had acute manifestations with muscle pain and/or weakness. Serum creatine kinase was between 1 648-92 660 U/L. Muscle biopsies showed nonspecific changes in 12 cases (a few with type 2 muscle fiber atrophy, slight deposition of lipid droplets), 10 cases with necrotizing myopathy (muscle fiber necrosis and regeneration). Toxic neurogenic damages were seen in 2 cases (type 1 and type 2 angular atrophic muscle fibers with group change), lipid storage disease in 1 case (lipid droplets deposit significantly) and idiopathic inflammatory myopathy in 1 case (muscle fiber necrosis and regeneration, with lymphocyte infiltration). The etiology of non-specific pathological changes included short-term strenuous exercise in 6 patients, poisoning in two, chronic kidney disease in one, viral infection in one, hypothyroidism in one and unknown reason in one. As to patients with necrotizing myopathy, seven were poisoning or drug-related, one with hyperthyroidism, two with unknown reason.@*Conclusions@#Among the numerous causes of rhabdomyolysis, exercise usually links nonspecific skeletal muscle changes and poisoning or drug-related disorders are commonly associated with necrotic myopathy. Rhabdomyolysis induced by primary myopathy is rare.

A new pathogenic mutation of the BRCA1 gene in a patient with ovarian cancer: A case report.

RATIONALE: The breast cancer susceptibility gene (BRCA) is an important tumor suppressor gene and tumor susceptibility gene. Germ line BRCA1/2 mutations significantly increase the risk of breast cancer and other cancers in women. PATIENT CONCERNS: A 48-year-old woman was diagnosed with breast cancer at the age of 42 and subsequently diagnosed with ovarian cancer at the age of 48. Her sister had a history of breast cancer and her mother died from ovarian cancer. DIAGNOSES: The patient has a family history of tumors. BRCA1/2 mutations was proved in this family members. INTERVENTIONS: Sanger sequencing was used to evaluate the BRCA1/2 gene status of the patient and her sister to identify the genetic mutation sites. OUTCOMES: They had the same genetic mutation, namely, the c.3487_3488insA (p.Thr1163AsnfsX2) mutation in the BRCA1 gene, which is a novel mutation. LESSONS: This novel mutation may be a new pathogenic mutation of the BRCA1 gene. Its relationship to breast and ovarian cancers needs to be further verified in more patient cases. Moreover, mutant protein functions in both cell and animal models are also needed.

Analysis of muscular pathological features in different types of connective tissue diseases / 中华风湿病学杂志

Objective To explore muscular pathological features in 6 types of connective tissue diseases except polymyositis and dermatomyositis.Methods We collected 53 patients who were diagnosed as connective tissue diseases with mnscle involvement and were performed muscle biopsies in our department from January,2010 to December,2016.The myopathological features were analyzed.Results Fifty-three cases including 6 systemic sclerosis cases,12 systemic lupus erythematosus cases,7 rheumatoid arthritis cases,13 Sj(o)gren's syndrome (SS) cases,5 mixed connective tissue disease cases,l0 overlap syndrome cases.Thirtyfive out of 53(66％)cases were in accordance with inflammatory myopathies changes.The main histopathologic categories were necrotizing myopathy (3/4) in systemic sclerosis,nonspecific myositis (4/5) in systemic lupus erythematosus,nonspecific myositis (4/9) and necrotizing myopathy (3/9) in SS,nonspecific myositis and necrotizing myopathy (3/8) in overlap syndrome.The most common pathological features were muscle fiber atrophy (50/53,94％),microangiopathy (40/53,75％),myofiber necrosis/regeneration (36/53,68％),C5b-9 deposits in sarcolemma (30/48,63％),diffuse major histocompatibility complex (MHC)-Ⅰ expressing in sarcolemma and endochylema area within myofibers (27/52,52％).Conclusion Necrotizing myopathy and nonspecific myositis are the most common histo-pathological categories in connective tissue diseases except polymyositis and der-matomyositis.Muscle fiber atrophy,microangiopathy,and necrosis/regeneration are the most prevalent pathologic features.

Study of the lateral ventricular in patients with Alzheimer's disease at 3.0T MR and MIMICS reconstruction / 实用放射学杂志

Objective To evaluate cerebral parenchymal atrophy of patients with Alzheimer's disease(AD)through the compara-tive analysis of the volume and morphology of the brain ventricle between patients with AD and normal elderly.Methods 20 patients with AD and 20 normal elderly people were scanned at 3.0T MR,and lateral ventricle section images were achieved,and the lateral ventricle volume and the anterior horn,posterior horn and temporal horn of the lateral ventricle were calculated by analyzing the re-construction of section images with MIMICS software from Belgian.Results As compared with normal elderly group,the patients with AD exhibited significantly increased the volume of left ventricular volume(LV),right ventricular volume (RV)and total vol-ume (TV)(P<0.05).Angle of bilateral anterior horn and temporal horn but not posterior horn of the lateral ventricle in patients with AD were significantly higher than that in normal elderly (P<0.05).The volume of the left,right and total cerebral ventricle, the angle of the anterior horn of the left and right lateral ventricle and the angle of the temporal horn of the left and right lateral ven-tricle were negatively correlated with MMSE (P<0.05).Conclusion Patients with AD exhibites significantly greater volume and an-gle of the lateral ventricular than normal elderly people.These related data measured can predict brain parenchymal atrophy of pa-tients with AD more conveniently and accurately.

Immunologic abnormality of intrahepatic cholestasis of pregnancy.

PROBLEM: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy risk because of the possibility of pre-term delivery and sudden intrauterine fetal death. Its pathogenesis is still under discussion. METHOD OF STUDY: The analysis of the recent findings on the complex immunologic events that occur in ICP were performed. RESULTS: In ICP, an increase of type 1 cytokine (TNF-alpha, IFN-gamma) associated with a decrease of type 2 cytokine (IL-4). The decreased production of the suppressor cytokine TGF-beta2 may increase the type 1 cytokine. Fas appeared to be increased and FasL appeared to be decreased in syncytiotrophoblasts of ICP. The human leukocyte antigen gene (HLA-G, E) in extravillous trophoblasts of ICP were significantly decreased. CONCLUSION: Th1/Th2 cytokine balance and HLA play important roles in the tolerance and maintenance of pregnancy. ICP may be resulting from breach of the maternal fetal immune tolerance during pregnancy.