Red blood cell distribution width is a risk factor for multiple organ dysfunction syndrome in elderly patients with infection: a case control study.

BACKGROUND: Infection is the leading cause of multiple organ dysfunction syndrome (MODS) in the elderly. Red blood cell distribution width (RDW) was considered to be associated with many diseases. We aimed to explore whether RDW was associated with MODS in elderly infected patients. METHODS: We retrospectively collected data from elderly patients (≥ 65 years old) with infection. In this study, we conducted a 1:3 case-control match based on age and gender and utilized binary Logistic regression to investigate the impact of variables such as RDW on MODS. RESULTS: A total of 576 eligible patients were included in this study. RDW in the case group was significantly higher than that in control group (p < 0.001). Multivariate analysis found that RDW was an independent risk factor for MODS in elderly infected patients (OR = 1.397, 95% CI: 1.166-1.674, p < 0.001). CONCLUSIONS: RDW was an independent risk factor for MODS in elderly patients with infection.

Rare complication of cushing's syndrome in the elderly: a case report.

PURPOSE: Cushing's syndrome (CS) is a rare and severe disease caused by sustained hypercortisolism. The clinical manifestations of CS can be atypical in the elderly, and the diagnosis in these patients is often missed. Infectious Purpura Fulminans (PF) is a life-threating, thrombotic form of disseminated intravascular coagulation with high mortality. To our knowledge, PF occurring in a patient with CS has not been reported previously. METHODS: We described an 84-year-old female presented with severe infection, but normal temperature. She suffered from a variety of diseases especially personality change. Physical examination revealed thin skin, general edema, and multiple scattered ecchymosis. Combined with obviously elevated serum cortisol (36.85 ug/dl) and adenoma revealed by adrenal CT scanning, endogenous CS was diagnosed. During hospitalization, the patient developed serious subcutaneous hemorrhage on the right thigh and back. The skin biopsy showed multiple small vessel thrombosis suggesting that the patient developed the rare complication of CS, Purpura Fulminans (PF). RESULTS: Chronic hypercortisolism can cause immune suppression, low-grade inflammation, endothelial damage, and a hypercoagulable state, which together increased susceptibility of PF. Fluid resuscitation, antibiotics, infusion of blood product, and debridement were effective treatment measures when CS complicated with infectious PF. CONCLUSION: Severe subcutaneous hemorrhage due to PF could occur in the patients of CS, especially in the elderly. Clinicians should be alert to the diagnosis of CS in older adults with cognitive decline and personality change.

Tomato lectin-modified nanoemulsion-encapsulated MAGE1-HSP70/SEA complex protein vaccine: Targeting intestinal M cells following peroral administration.

Vaccines administered orally enable the stimulation of both the mucous membrane and system immune responses. However, tumor vaccines, whose effective elements are antigen protein molecules or gene-encoding antigens, are hardly accustomed to the harsh gastrointestinal environment. Here, we explored an oral nanoecapsulated tumor vaccine complex to evaluate the anti-tumor effect. Tomato lectin (TL) was modified on the surface of a nanoemulsion (NE) composed of MAGE1-HSP70/SEA (MHS). C57BL/6 mice were immunized with NE (-), NE (MHS) and TL-NE (MHS) via po. or sc. administration. Additionally, the cellular immunocompetence was detected by the enzyme-linked immunospot assay and lactate dehydrogenase release assay. Serum antibody titers were analyzed using the enzyme-linked immuno sorbent assay. Next, the therapeutic and tumor challenge assays were performed. The TL-NE (MHS) particles were 20 ± 5 nm in diameter and could resist pepsin and trypsin digestion. The cellular immune responses elicited by TL-NE (MHS) perioral were stronger than those by TL-NE (MHS)-sc. (p < 0.05) when targeted to B16-MAGE1 tumor cells. The levels of MAGE-1 antibody induced by TL-NE (MHS) via the oral route was higher than control group (p < 0.05). The percentage of CD4+ and CD8+ T cells in TL-NE (MHS)-po. group was more than other groups (p < 0.05). Furthermore, oral TL-NE (M)HScould delay tumor growth and defer tumor occurrence and tumor recurrence after resection in mice challenged with B16-MAGE-1 tumor cells. The study suggested that the oral TL-NE (MHS) vaccine delivery system is feasible to improve the vaccine protection effect and may have broad application in cancer therapy.

ApoE4 May be a Promising Target for Treatment of Coronary Heart Disease and Alzheimer's Disease.

Alzheimer disease (AD) is most common neurodegenerative disorder of dementia, as we all know that ApoE4 is the greatest genetic risk factor of late-onset Alzheimer's disease (LOAD). Coronary heart disease (CHD) leads to one-fourth of all deaths in industrialized countries, it is reported that ApoE4 increases the risk of coronary heart disease as well. Furthermore, evidence show that coronary heart disease also increases the incidence of Alzheimer's disease. Whether ApoE4 is a bridge connecting AD with CHD or not? And what are the special mechanism and therapeutic methods? Researchers found that cholesterol metabolic disorder is the common cause and risk factor of AD and CHD. Epidemiological studies demonstrate that carriers of the ApoE4 allele have higher cholesterol plasma concentration. More evidence indicate that hypercholesterolemia accelerates the progression of coronary atherosclerosis, damages the central nervous system blood-brain barrier, promotes Aß protein production and Tau deposition in brain. Therefore, ApoE4 is likely to be the bridge between AD and CHD, and may be a potentially promising therapeutic target.