Case report and literature review: management of Paxlovid (nirmatrelvir/ritonavir)-induced acute tacrolimus toxicity in a patient with systemic lupus erythematosus.

Despite the availability of effective vaccines and treatments for SARS-CoV-2, managing COVID-19 in patients with systemic lupus erythematosus (SLE) remains challenging, particularly considering drug-drug interactions (DDIs). Here, we present a case of DDIs between Tacrolimus (Tac) and nirmatrelvir/ritonavir (NMV/r) in a 32-year-old male with SLE. Following self-administration of NMV/r and resumption of Tac after 5 days, the patient experienced acute nephrotoxicity and neurotoxicity, accompanied by supratherapeutic Tac levels, despite Tac being withheld during NMV/r. The primary cause of this acute toxicity is attributed to ritonavir's inhibitory effect on both CYP3A4 enzymes and P-glycoprotein. Upon admission, Tac was discontinued, and supportive therapies were initiated. Phenytoin, a CYP3A4 inducer, was administered to lower Tac levels under the guidance of clinical pharmacists, effectively alleviating the patient's acute toxic symptoms. The half-life of Tac during the treatment of phenytoin was calculated to be 55.87 h. And no adverse reactions to phenytoin were observed. This case underscores the persistence of enzyme inhibition effects and demonstrates the effectiveness and safety of utilizing CYP3A4 enzyme inducers to mitigate Tac concentrations. Furthermore, it emphasizes the importance of healthcare providers and patients being vigilant about DDIs in Tac recipients. Lastly, it highlights the indispensable role of pharmacist involvement in clinical decision-making and close monitoring in complex clinical scenarios. Although our findings are based on a single case, they align with current knowledge and suggest the potential of individualized combination therapy in managing challenging COVID-19 cases in immunocompromised patients.

Corrigendum: Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications.

[This corrects the article DOI: 10.3389/fimmu.2023.1118039.].

Development and Validation of a Dynamic Nomogram for Predicting 3-Month Mortality in Acute Ischemic Stroke Patients with Atrial Fibrillation.

Background: Acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) carries a substantial risk of mortality, emphasizing the need for effective risk assessment and timely interventions. This study aimed to develop and validate a practical dynamic nomogram for predicting 3-month mortality in AIS patients with AF. Methods: AIS patients with AF were enrolled and randomly divided into training and validation cohorts. The nomogram was developed based on independent risk factors identified by multivariate logistic regression analysis. The prediction performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC-ROC), calibration plots, decision curve analysis (DCA), and Kaplan-Meier survival analysis. Results: A total of 412 patients with AIS and AF entered final analysis, 288 patients in the training cohort and 124 patients in the validation cohort. The nomogram was developed using age, baseline National Institutes of Health Stroke Scale score, early introduction of novel oral anticoagulants, and pneumonia as independent risk factors. The nomogram exhibited good discrimination both in the training cohort (AUC, 0.851; 95% CI, 0.802-0.899) and the validation cohort (AUC, 0.811; 95% CI, 0.706-0.916). The calibration plots, DCA and Kaplan-Meier survival analysis demonstrated that the nomogram was well calibrated and clinically useful, effectively distinguishing the 3-month survival status of patients with AIS and AF, respectively. The dynamic nomogram can be obtained at the website: https://yanxiaodi.shinyapps.io/3-monthmortality/. Conclusion: The dynamic nomogram represents the first predictive model for 3-month mortality and may contribute to managing the mortality risk of patients with AIS and AF.

circSKA3 promotes colorectal cancer metastases through miR-1238 and methylation.

Colorectal cancer (CRC) is becoming one of the most common cancers overworld, which causes a high rate of death in patients. circRNAs are non-coding RNAs(ncRNAs), which have been reported to be involved in the development of many cancers, including CRC. However, the exact mechanism that how circRNAs function through in CRC remains unclear. In this study, we firstly used GEO database and bioinformatic methods to identify the significant changed circRNAs, with circSKA3 being the most significantly upregulated circRNAs in CRC tissues. PCR results further confirmed higher expression of circSKA3 in CRC patients. CCK-8, scratch, and transwell assays indicated that circSKA3 could promote the proliferation, migration, and invasion of CRC cell lines for cell detection. Dual-luciferase assays were carried out to detect the downstream targets of circSKA3, and a binding site between circSKA3 and miR-1238 was identified and miR-1238 could also combine with YTHDF2. Overexpression of YTHDF2 rescued the decreased cell proliferation, migration, and invasion caused by miR-1238 overexpression. RIP assay further indicated that YTHDF2 could decrease the methylation of STAT5A. In summary, our study found that circSKA3 was upregulated in CRC tissues comparing with normal tissues. circSKA3 could increase the expression ofYTHDF2 through sponging miR-1238 to decrease the methylation of STAT5A, which could provide a novel target for CRC treatment.

An unusual case of acquired angioedema associated with monoclonal gammopathies of uncertain significance.

Acquired angioedema (AAE) is a rare disease due to the C1 esterase inhibitor (C1-INH) deficiency. Clinically, its symptoms are similar to hereditary angioedema (HAE) with hereditary C1-INH deficiency. Both conditions have the potential to cause upper airway obstruction, which can be fatal in clinical practice and thus require intense attention. Here, we'd like to discuss the clinical presentation, diagnosis and follow up of a special case of AAE associated with monoclonal gammopathies of unknown significance (MGUS) with recurrent upper airway obstruction. The patient was regularly followed up after being discharged from our ward. Measurements of C3-C4 levels were carried out by a hematological test. Due to the rarity of such a disease, especially in Chinese people, relevant diagnosis methods are missing in this patient, so the patient was only diagnosed with AAE-C1-INH associated with MGUS clinically. The latest follow up showed that he still underwent recurrent upper airway obstruction; thus, he remained in a tracheostomy state due to a lack of proper medication prophylaxis and died eventually. This unusual case reminds emergency physicians to pay attention to such disease during clinical practice, and relevant diagnosis method should be improved.

An unusual case of acquired angioedema associated with monoclonal gammopathies of uncertain significance

Acquired angioedema (AAE) is a rare disease due to the C1 esterase inhibitor (C1-INH) deficiency. Clinically, its symptoms are similar to hereditary angioedema (HAE) with hereditary C1-INH deficiency. Both conditions have the potential to cause upper airway obstruction, which can be fatal in clinical practice and thus require intense attention. Here, we’d like to discuss the clinical presentation, diagnosis and follow up of a special case of AAE associated with monoclonal gammopathies of unknown significance (MGUS) with recurrent upper airway obstruction. The patient was regularly followed up after being discharged from our ward. Measurements of C3–C4 levels were carried out by a hematological test. Due to the rarity of such a disease, especially in Chinese people, relevant diagnosis methods are missing in this patient, so the patient was only diagnosed with AAE-C1-INH associated with MGUS clinically. The latest follow up showed that he still underwent recurrent upper airway obstruction; thus, he remained in a tracheostomy state due to a lack of proper medication prophylaxis and died eventually. This unusual case reminds emergency physicians to pay attention to such disease during clinical practice, and relevant diagnosis method should be improved (AU)

Effect of intravenous immunoglobulin therapy on the prognosis of patients with severe fever with thrombocytopenia syndrome and neurological complications.

Background: Intravenous immunoglobulin (IVIG) has been reported to exert a beneficial effect on severe fever with thrombocytopenia syndrome (SFTS) patients with neurological complications. However, in clinical practice, the standard regime is unclear and there is a lack of evidence from large-scale studies. Methods: A single-center retrospective study was conducted to determine the influence of IVIG dosage and duration on SFTS patients with neurological complications. The primary outcome was 28-day mortality, and laboratory parameters before and after IVIG treatment were measured. Survival curves were generated using the Kaplan-Meier method and analyzed with the log-rank test according to the median IVIG dosage and IVIG duration. Besides, multivariate Cox regression analysis was performed to examine the association between the independent factors and 28-day mortality in SFTS patients. Results: Overall, 36 patients (58.06%) survived, while 26 (41.9%) patients died. The median age of the included patients was 70 (55-75) years, and 46.8% (29/62) were male. A significantly higher clinical presentation of dizziness and headache was observed in the survival group. The IVIG duration in the survival group was longer than in the death group (P <0.05). Additionally, the IVIG dosage was higher in the survival group than in the death group, but there was not a statistically significant difference between the two groups (P = 0.066). The mediating effect of IVIG duration was verified through the relationship between IVIG dosage and prognosis using the Sobel test. Univariate analysis revealed that IVIG dosage (HR: 0.98; 95% CI: 0.97-1.00; P = 0.007) and IVIG duration (HR: 0.54; 95% CI: 0.41-0.72; P <0.001) were significantly associated with risk of death. The multivariate analysis generated an adjusted HR value of 0.98 (95% CI: 0.96-1.00; P = 0.012) for IVIG dosage and 0.26 (95% CI: 0.09-0.78; P = 0.016) for dizziness and headache. Conclusion: Prolonged high-dose IVIG is beneficial to the 28-day prognosis in SFTS patients with neurological complications.

Investigation and Genome-Wide Association Analysis of Fusarium Seedling Blight Resistance in Chinese Elite Wheat Lines.

Fusarium seedling blight (FSB) is an important disease of wheat occurring as part of the Fusarium disease complex consisting also of Fusarium head blight (FHB). 240 Chinese elite cultivars and lines were evaluated in greenhouse experiments for FSB resistance and genotyped using the wheat 90 K single nucleotide polymorphism arrays. Among them, 23 accessions had an average lesion length of less than 0.6 cm, exhibiting potential for breeding for FSB resistance in wheat. Jingfumai 1 and Yangmai 11 had a relatively high resistance to both FSB and FHB simultaneously. Six relatively stable quantitative trait loci (QTLs) were detected on chromosome arms 1DL, 3AS, 3BL, 6BL, 7AL, and Un using the mixed linear model approach, interpreting 4.83-7.53% of phenotypic variation. There was a negative correlation between the average FSB lesion length and the BLUE FHB index with a low coefficient, and resistance to both diseases appeared to be conferred by different QTLs across the same population. Four KASP markers were detected on 1DL, 3AS, 3BL, and 6BL in QTLs to facilitate marker-assisted selection. Combined with transcriptome data analysis, eight defense-related genes were considered as candidates for mapping QTLs. The resistant elite germplasm, mapped QTLs, and KASP markers developed in this study are useful resources for enhancing Fusarium seedling blight in wheat breeding.

Effects of three fertilizer application patterns on wheat sowed by machinery in slope cropland of Western Hubei, China.

Unscientific fertilization, unstable grain quality, and low profit are the key problems on wheat production in slope cropland of Western Hubei. To solve these problems, three optimized planting patterns (high nitrogen and potassium reduction, HNPR; medium nitrogen and potassium reductionm, MNPR; low nitrogen and potassium reduction, LNPR) were conducted during two consecutive years to assess their effects on wheat yield, quality, profit, and fertilizer use efficiency in Danjiangkou Reservoir area, a typical slope cropland region with wheat-maize rotation. The results showed that the application of chemical fertilizer significantly increased grain yield (GY) and wet gluten content (WGC) of wheat. Compared with the conventional planting pattern (CK), the partial factor productivity (PFPK) and agricultural fertilizer use efficiency (AFUEK) of potassium were significantly improved in the three optimized planting patterns. The dry matter amount (DMA), GY, and crude protein content (CPC) were the highest under HNPR, which increased by 9.4%, 19.4%, and 7.8% than CK, respectively. Such a result indicated that HNPR benefited wheat to exploit high yield potential. WGC and falling number (FN) were the highest under MNPR, and increased by 3.9%, and 9.3% than CK, respectively, which was suitable for high-efficiency production of medium-gluten wheat. PFPN, AFUEN, PFPK, AFUEK, and net profit were the highest under LNPR, which increased by 15.7%, 134.1%, 131.3%, 368.2%, and 37.3% than CK, respectively, while the CPC and WGC were decreased by 2.1% and 2.6% than CK, respectively, suggesting it was suitable for environment-friendly and simplified production of weak-gluten wheat production. Our results could provide a reference for wheat production in the slope cropland.

Genome-wide association analysis of stripe rust resistance in modern Chinese wheat.

BACKGROUND: Stripe rust (yellow rust) is a significant disease for bread wheat (Triticum aestivum L.) worldwide. A genome-wide association study was conducted on 240 Chinese wheat cultivars and elite lines genotyped with the wheat 90 K single nucleotide polymorphism (SNP) arrays to decipher the genetic architecture of stripe rust resistance in Chinese germplasm. RESULTS: Stripe rust resistance was evaluated at the adult plant stage in Pixian and Xindu in Sichuan province in the 2015-2016 cropping season, and in Wuhan in Hubei province in the 2013-2014, 2016-2017 and 2018-2019 cropping seasons. Twelve stable loci for stripe rust resistance were identified by GWAS using TASSEL and GAPIT software. These loci were distributed on chromosomes 1B, 1D, 2A, 2B, 3A, 3B, 4B (3), 4D, 6D, and 7B and explained 3.6 to 10.3% of the phenotypic variation. Six of the loci corresponded with previously reported genes/QTLs, including Sr2/Yr30/Lr27, while the other six (QYr.hbaas-1BS, QYr.hbaas-2BL, QYr.hbaas-3AL, QYr.hbaas-4BL.3, QYr.hbaas-4DL, and QYr.hbaas-6DS) are probably novel. The results suggest high genetic diversity for stripe rust resistance in this population. The resistance alleles of QYr.hbaas-2AS, QYr.hbaas-3BS, QYr.hbaas-4DL, and QYr.hbaas-7BL were rare in the present panel, indicating their potential use in breeding for stripe rust resistance in China. Eleven penta-primer amplification refractory mutation system (PARMS) markers were developed from SNPs significantly associated with seven mapped QTLs. Twenty-seven genes were predicted for mapped QTLs. Six of them were considered as candidates for their high relative expression levels post-inoculation. CONCLUSION: The resistant germplasm, mapped QTLs, and PARMS markers developed in this study are resources for enhancing stripe rust resistance in wheat breeding.

Temporal Trends in the Risk Factors and Clinical Characteristics of Ischemic Stroke in Young Adults.

OBJECTIVES: This study aimed to analyze the risk factors of ischemic stroke in young adults of different ages; explore the changes in these risk factors with time; analyze the clinical characteristics of ischemic stroke in young adults; and assess how to better prevent ischemic stroke in young adults. METHODS: All patients with ischemic stroke who presented to the Department of Emergency Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School were enrolled. The data of patients aged 18-50 years were retrospectively evaluated for two periods, January-December 2008 and January-December 2018. Additionally, we collected the data of patients aged 51-90 years with ischemic stroke in the same ward in 2018. The subjects were divided into three groups: ischemic stroke in young people in 2008 ("Youth 2008"), ischemic stroke in young people in 2018 ("Youth 2018"), and ischemic stroke in elderly people in 2018 ("Senior 2018"). Risk factors, clinical characteristics and test indices were recorded and analyzed statistically. RESULTS: The "Youth 2008" group included 28 patients-19 males (67.9%) and 9 females (31.2%) with a male-to-female ratio of 2.11:1. The "Youth 2018" group included 23 patients-20 males (87.0%) and 3 females (13.0%) with a male-to-female ratio of 6.67:1. The "Senior 2018" group included 210 patients-150 males (71.4%) and 60 females (28.6%) with a male-to-female ratio of 2.50:1. The risk factors in "Youth 2018" were higher than those in "Youth 2008" in terms of hypertension, hyperglycemia, and hypercholesterolemia without significant difference. Smoking and hypertrophic cardiomyopathy were significantly increased (P < 0.05) in this population. Smoking, hypercholesterolemia, and hypertrophic cardiomyopathy were more prevalent among the "Youth 2018" group than among the "Senior 2018" group, whereas carotid plaques, hypertension, and atrial fibrillation were less common in the younger group (P < 0.05). There was no significant difference between the younger and older groups in terms of thrombolysis rate, cerebral infarction type, and complications, except pulmonary infections (P < 0.05). CONCLUSIONS: There was no significant change in the main risk factors of ischemic stroke in young adults during the 10-year period. Traditional risk factors-smoking and hypertrophic cardiomyopathy-were still common but with a significantly greater prevalence, whereas carotid plaques, hypertension, and atrial fibrillation had become less common. The clinical characteristics, other than pulmonary infection, were not significantly different between the younger and older patients with ischemic stroke.

Genome-Wide Association Analysis of Fusarium Head Blight Resistance in Chinese Elite Wheat Lines.

Fusarium head blight (FHB) is a devastating wheat disease worldwide. To decipher the genetic architecture of FHB resistance in Chinese germplasm, a Wheat Association Panel for Scab Research (WAPS) consisting of 240 leading Chinese wheat cultivars and elite lines was genotyped using the 90K single nucleotide polymorphism (SNP) arrays. The FHB response was evaluated in the field nurseries in Wuhan in Hubei Province over four consecutive years from 2014 to 2017. Five quantitative trait loci (QTL) were consistently identified on chromosome arms 1AS, 2DL, 5AS, 5AL, and 7DS using a mixed linear model (MLM), explaining 5.6, 10.3, 5.7, 5.4, and 5.6% of phenotypic variation, respectively. The QTL on 5AS, 5AL, and 7DS QTL are probably novel. The allelic frequency analysis indicated that cultivars from the Middle and Lower Yangtze River Valleys harbored more favorable alleles and were therefore more resistant than those from other regions. To facilitate in-house germplasm screening and marker-assisted selection (MAS), SNP-derived PCR markers were developed for the QTL regions on 1AS, 5AS, and 5AL QTL. In addition to the above five QTL, the WAPS population had a very low frequency of Fhb1, confirming that the gene is not widely used in Chinese wheat breeding programs. The resistant lines and molecular markers developed in this study are resources and information for enhancing FHB resistance in breeding populations by marker-assisted recurrent selection and gene stacking.

An atypical case of serotonin syndrome with normal dose of selective serotonin inhibitors: A case report.

RATIONALE: As increasing frequency of serotonergic drug use, SS (serotonin syndrome) occurred more than ever. But clinicians have not enough knowledge and experience about SS as a potentially life-threatening condition. SS is usually caused by the increased serotonin activity in the central nervous system which may due to a serotonergic agent overdose or the concomitant use of 2 or more serotonergic antidepressants. We report a case of SS due to a normal dose of selective serotonin inhibitors (SSRIs) thus to remind clinicians to pay attention to such patients and make an early diagnosis and initiation of therapy in the clinical practice. PATIENT CONCERNS: We report here a 49-year-old man presented with lethargic, less communicative, and insomnia for 20 days while a diagnosis of depression was considered and he was treated with SSRIs. DIAGNOSIS: The patient in our case fulfilled the 3 criteria existed now for diagnosing SS, including the Sternbach criteria, Radomski revised diagnostic criteria, and the Hunter serotonin toxicity criteria. INTERVENTIONS: All the antidepressants were stopped and cyproheptadine with an initial dose of 12 mg a day was started along with supportive care. The patient was also admitted to emergency intensive care unit for further treatment. He was sedated and paralyzed by intravenous Midazolam and Clonazepam along with physical cooling and supportive care. OUTCOMES: All of the patient's symptoms abated gradually and he soon could get off the bed and be communicative. Finally, the patient made a full recovery and he was discharged from the hospital. LESSONS: Our case suggests an atypical clinical course while the medicine the patient takes was not in so much dose. We assumed that there may have been some variation in metabolism of these agents, resulting in increased possibility that led to the subsequent syndrome. Thus, it is essential for clinicians to keep in mind when patients taking serotonergic agents who demonstrate acute change in their mental status. Besides, clinicians should be aware of such patients who seem to be sensitive to SSRIs, who may require a genetic testing before the initiation of SSRI therapy.