Objective:To investigate the efficacy and safety of hemodiafiltration (HDF) in treating CAR-T related grade 3-4 cytokine release syndrome after ineffective treatment with IL-6 receptor inhibitors.Methods:Between July 2015 and July 2021, retrospective analysis of hemodiafiltration for the treatment of 3 patients, including 2 cases of acute B-lymphoblastic leukemia and 1 case of diffuse large B-cell lymphoma, with grade 3-4 CRS after CAR-T cell therapy and ineffective treatment with IL-6 receptor inhibitor was carried out.Results:The patient's clinical symptoms, including body temperature, blood pressure, and blood oxygen, were relieved within 12 hours of all treatments, and the cytokines (IL-6, IL-10, TNF-α, INF-γ) and C-reactive protein (CRP) levels decreased significantly. No adverse side effects were observed during the follow-up period of 3 months.Conclusion:HDF can be a safe and feasible method to treat CAR-T related grade 3- 4 CRS after ineffective treatment with IL-6 receptor inhibitors.

Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

Postural tachycardia syndrome (POTS) is one type of orthostatic intolerance.The treatment for POTS including non-drug treatment and medications,such as α-receptor agonists,β-recepter blockers and oral rehydration salts.The prognostic meaning of biomarkers and hemodynamic parameters in the POTS children treated with midodrine hydrochloride are discussed in this paper.

We summarized the epidemiological investigation results of the first case of human infection with avian influenza A(H9N2) virus in Chengdu,China,in order to provide references for dealing with similar diseases scientifically in the future.The methods of field epidemiology and laboratory testing were used to collect the H9N2 case's clinical and epidemiological data,as well as collect and test the samples of the H9N2 case and the relevant environment,so that the possible sources of infection,the epidemiological characteristics and clinical features could be analyzed.Results showed that the H9N2 case contacted with poultry within 10 days before the onset of illness and the H9N2 virus nucleic acid was detected in the patient's specimen by PCR.This case suffered from several chronic diseases for a long time,although active treatments were taken this time,she died soon after onset.Her living environment,the chicken leftovers from cooking,and surrounding poultry markets were polluted by H9 avian influenza virus.Through the investigation,we could deduce that the infection source of this case was the chicken infecting H9N2 viruses from surrounding poultry markets.This would be the first fatality associated with influenza A (H9N2) virus infections in humans.And though avian influenza A(H9N2) virus was low pathogenic,infection could cause severe symptoms or death in people with severe underlying diseases.

Objective To investigate the changes of the gray matter in patients with rheumatoid arthritis (RA) based on the voxel based morphometry (VBM).Methods 35 patients with RA and 30 healthy volunteers with age,sex and education level matched performed a high-resolution 3D-T1-weighted whole brain structural scan by GE Signa HDxt 1.5T MRI scanner.The high resolution T1WI images were preprocessed by the VBM 12 implemented in the SPM 12 software to display the gray matter structures of the RA patients and the healthy volunteers.T test was used to compare the morphological changes of gray matter between the RA patients and the volunteers.Results The gray matter volume gray matter volume in the right lentiform nucleus,left frontal lobe and left cerebellum posterior lobe significantly decreased in RA patients,and their gray matter volume had no correlation with the clinical indications.The increase of gray matter volume was not found in the RA patients.Conclusion RA patients show decreased gray matter volume in several cerebral regions,which suggests that RA can lead to the brain structural abnormalities.VBM can provide an objective imaging evidence to evaluate the cerebral morphological abnormalities of RA.

This study examined the corneal permeability of topical eye drop solutions added with various corneal penetrating accelerators and gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) by nuclear magnetic resonance imaging (MRI). Twenty-four New Zealand rabbits were randomly divided into 3 groups according to the random digits table: Gd-DTPA group, in which the rabbits received 23.45% Gd-DTPA; hyaluronic acid group, in which 23.45% Gd-DTPA plus 0.2% hyaluronic acid was administered; azone group, in which 23.45% Gd-DTPA with 0.2% azone was given. Fifty microliters of the eye drops was instilled into the conjunctive sac every 5 min, for a total of 6 applications in each group. Contrast medium signals in the cornea, anterior chamber, posterior chamber, and vitreous body were scanned successively by MRI. The morphology and cell density of the corneal endothelium were examined before and 24 h after the treatment. The results showed that the residence time of Gd-DTPA in the conjunctival sac in the hyaluronic acid and azone groups was longer than that in the Gd-DTPA group. The signals in the anterior chamber of the Gd-DTPA and hyaluronic acid groups were increased slightly, and those in the azone group strengthened sharply. The signal intensity continuously rose over 80 min before reaching plateau. The strengthening rate of signals in the anterior chamber was 19.63% in the Gd-DTPA group, 53.42% in the sodium hyaluronate group, and 226.94% in the azone group. No signal was detected in the posterior chamber or vitreous body in all the 3 groups. Corneal morphology and cell density did not show any significant changes after the treatment in all the 3 groups. It was concluded that azone can significantly improve the corneal permeability of drugs that are similar to Gd-DTPA in molecular weight and molecular size, and MRI is a noninvasive technique that can dynamically detect eye drop metabolism in real time.
Animals ; Azepines ; administration & dosage ; pharmacokinetics ; Contrast Media ; administration & dosage ; pharmacokinetics ; Cornea ; metabolism ; Female ; Gadolinium DTPA ; administration & dosage ; pharmacokinetics ; Magnetic Resonance Imaging ; Male ; Ophthalmic Solutions ; Permeability ; Rabbits

Objective To observe whether hepatitis B vaccine enhance the treating effect of cyto-kine induced kill(CIK) cells on hepatitis B virus transgenic(HBV-Tg) mice. Methods The HBV-Tg mice were treated with CIK cells by peritoneal injection and hepatitis B vaccine by hypodermic injection. The HBV DNA level were tested by real-time PCR,T lymphocyte subgroup were detected by flow cytometry and the pathological diversify of hepatic tissue were observed by HE staining. Results The HBV DNA loading in peripheral blood of HBV-Tg mice decreased after CIK cells were treated and CD3~+ , CD4~+ and CD8~+ cells increased which were enhanced after CIK cells combined with hepatitis B vaccine. Conclusion Hepa-titis B vaccine enhanced the treating effect of CIK on HBV-Tg mice which may be implemented by increased the blood level of CD3~+, CD4~+ and CD8~+ cells, especially CD8~+ cells level.

Objective To investigate lymphovascular invasion (LVI) in mid-low rectal cancer following neoadjuvant therapy. Methods A total of 297 consecutive patients with mid-low rectal cancer received radical surgery from August 2002 to August 2005 at Beijing Cancer Hospital. All patients were divided into the neoadjuvant therapy group and a control group according to whether they underwent preoperative radiotherapy or radiochemotherapy. Histological assessment of tumor specimens was made, and correlation of LVI and prognosis was analysed using the chi-square test. The disease-free survival rate and overall survival rate were analysed by the Kaplan-Meier survival curve. Results The overall positive rate of LVI was 23.9% (71/297). The positive rates of LVI in neoadjuvant therapy group and control group were 21.5% (31/144) and 26. 1% (40/153), respectively,with no significant difference between the groups ( x2 = 0.872, P ＞ 0.05). In the neoadjuvant therapy and control groups, LVI was significantly associated with pathologic T and N stages as well as the degree of histological differentiation (x2 =13.490, 27.401,7.323;16. 188, 21.623, 16.534, P＜0.05). In the control group, LVI was closely associated with local recurrence (x2 =4. 010, P ＜0.05 ), whereas this was not the case in the neoadjuvant therapy group (x2 =0.000, P＞0.05). LVI was significantly associated with distal metastasis in both the neoadjuvant therapy and control groups (x2 = 4.950, 14. 332, P ＜ 0.05 ). The disease-free and overall survival rates of patients with LVI were 46.4% (26/56) and 56.7% (34/60), which were significantly lower than 75.1%(148/197) and 79.4% ( 166/209 ) of those with no LVI, respectively ( x2 = 16. 720, 12.660, P ＜ 0.05 ).Conclusions Neoadjuvant therapy does not significantly reduce LVI;however, the biological behaviour of LVI has changed. Patients with LVI may benefit from neoadjuvant radiotherapy.

This study examined the corneal permeability of topical eye drop solutions added with various corneal penetrating accelerators and gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) by nuclear magnetic resonance imaging (MRI). Twenty-four New Zealand rabbits were randomly divided into 3 groups according to the random digits table: Gd-DTPA group, in which the rabbits received 23.45% Gd-DTPA; hyaluronic acid group, in which 23.45% Gd-DTPA plus 0.2% hyaluronic acid was administered; azone group, in which 23.45% Gd-DTPA with 0.2% azone was given. Fifty microliters of the eye drops was instilled into the conjunctive sac every 5 min, for a total of 6 applications in each group. Contrast medium signals in the cornea, anterior chamber, posterior chamber, and vitreous body were scanned successively by MRI. The morphology and cell density of the corneal endothelium were examined before and 24 h after the treatment. The results showed that the residence time of Gd-DTPA in the conjunctival sac in the hyaluronic acid and azone groups was longer than that in the Gd-DTPA group. The signals in the anterior chamber of the Gd-DTPA and hyaluronic acid groups were increased slightly, and those in the azone group strengthened sharply. The signal intensity continuously rose over 80 min before reaching plateau. The strengthening rate of signals in the anterior chamber was 19.63% in the Gd-DTPA group, 53.42% in the sodium hyaluronate group, and 226.94% in the azone group. No signal was detected in the posterior chamber or vitreous body in all the 3 groups. Corneal morphology and cell density did not show any significant changes after the treatment in all the 3 groups. It was concluded that azone can significantly improve the corneal permeability of drugs that are similar to Gd-DTPA in molecular weight and molecular size, and MRI is a noninvasive technique that can dynamically detect eye drop metabolism in real time.