Background: Cerebral vasospasm has been reported following various forms of bacterial meningitis; however, there have been no prior reports of meningitis caused by the non-K1 strain of Escherichia coli. Case Report: A 63-year-old man with chronic thrombocytopenia presented with new-onset seizures that progressed to coma. Cerebrospinal fluid (CSF) analysis showed Gram-negative rods, but CSF culture and the Biofire FilmArray Meningitis/Encephalitis Panel were negative. Additional 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction and sequencing of the CSF sample indicated E. coli meningitis when correlated with the results of urine culture. The patient eventually developed diffuse cerebral arterial vasospasms with multifocal brain infarcts that progressed to brain death. Conclusion E. coli meningitis in adults may be missed if diagnostic tests include only K1 strains. Clinicians should be aware of cerebral vasospasm as a potentially serious complication of E. coli meningitis, and should consider screening for it, particularly in patients with associated risk factors.

OBJECTIVE: To assess the risk of aristolochic acid (AA)-associated cancer in patients with AA nephropathy (AAN). METHODS: A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospital from January 1997 to December 2014. Long-term surveillance and follow-up data were analyzed to investigate the influence of different factors on the prevalence of cancer. The primary endpoint was the incidence of liver cancer, and the secondary endpoint was the incidence of urinary cancer during 1 year after taking AA-containing medication to 2014. RESULTS: A total of 337 patients diagnosed with AAN were included in this study. From the initiation of taking AA to the termination of follow-up, 39 patients were diagnosed with cancer. No cases of liver cancer were observed throughout the entire follow-up period, with urinary cancer being the predominant type (34/39, 87.17%). Logistic regression analysis showed that age, follow-up period, and diabetes were potential risk factors, however, the dosage of the drug was not significantly associated with urinary cancer. CONCLUSIONS No cases of liver cancer were observed at the end of follow-up. However, a high prevalence of urinary cancer was observed in AAN patients. Establishing a direct causality between AA and HCC is challenging.
Humans ; Retrospective Studies ; Incidence ; Carcinoma, Hepatocellular ; Liver Neoplasms/epidemiology* ; Kidney Diseases/chemically induced* ; Aristolochic Acids/adverse effects*

Objective:To analyze the clinical efficacy of electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation in the treatment of vitiligo-associated leukotrichia.Methods:Clinical data were retrospectively collected from 25 patients with stable vitiligo-associated leukotrichia in the Department of Dermatologic Surgery, Hangzhou Third People′s Hospital from January 2019 to January 2021. All the patients received electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation. Outpatient follow-up visits were conducted in the first week, as well as the first, third and sixth months after surgery. The texture and growth status of transplanted hair were observed, and the survival rate of transplanted hair follicles and the proportion of newborn white hair in white hair in the original lesions were recorded.Results:Among the 25 patients with stable vitiligo, there were 14 males and 11 females, and their disease duration ranged from 2 to 15 years, with the average duration being 5.8 years. A total of 30 white patches accompanied by leukotrichia were included, including 9 on the scalp, 7 on the eyebrows and 14 on the eyelashes. One week after surgery, the transplanted hair survived well in all patients, without obvious shedding or local infection. Six months after surgery, repigmentation was observed in most hair in the original lesion area, and only a small amount of white hair grew out, without obvious scarring; the survival rate of transplanted hair follicles was 76.5% ± 10.0%, and the proportion of newborn white hair in white hair in the original lesions was 16.7% ± 7.8%.Conclusion:Electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation was effective in the treatment of vitiligo-associated leukotrichia, with a simple treatment process and few postoperative complications, which provided a reliable choice for the clinical treatment of vitiligo-associated leukotrichia.

Objective To compare the differences in the clinical application of Sijunzi Decoction,a classical formula for tonifying qi,in ancient and modern literature,so as to provide a reference for its clinical application and research and development.Methods The clinical application of Sijunzi Decoction in ancient times was analyzed by retrieving the database of Zhong Hua Yi Dian(Collection of Traditional Chinese Medical Books),and the clinical application of Sijunzi Decoction in modern times was analyzed by retrieving the database of China National Knowledge Infrastructure(CNKI).Results In the record of ancient traditional Chinese medicine books,Sijunzi Decoction was indicated for the syndromes characterized by the pathogenesis of"deficiency of nutrient qi and defensive qi,and weakness of zang-fu organs",and was widely used to treat various diseases related to internal medicine,surgery,gynecology and pediatrics,including dysentery,consumptive disease,diarrhea,jaundice,smallpox,metrorrhagia and carbuncle.Moreover,Sijunzi Decoction was used for the management of patients who was weakness due to chronic diseases,elderly and insufficiency of qi,or at the late stage of exogenous cold disease,cholera,and malaria.In the modern clinical practice,Sijunzi Decoction was indicated for digestive system diseases,surgical diseases,tumor-related diseases,pediatric diseases,gynecological diseases,respiratory diseases and hepatobiliary diseases,in particular for chronic gastritis,adverse reactions related to radiotherapy and chemotherapy for tumors,postoperative period of cancer and diabetes mellitus during pregnancy.Conclusion The analysis of ancient and modern literatures indicated that the indications of Sijunzi Decoction is expanded from the predominated spleen-stomach system diseases(digestive system diseases)in antient times to multiple system diseases such as surgical diseases,tumor-related diseases,pediatric diseases,gynecological diseases,respiratory diseases and hepatobiliary diseases in modern times.And the pathogenesis of the indications of Sijunzi Decoction is characterized by the"deficiency of nutrient qi and defensive qi,and weakness of the zang-fu organs".

Background: Cerebral vasospasm has been reported following various forms of bacterial meningitis; however, there have been no prior reports of meningitis caused by the non-K1 strain of Escherichia coli. Case Report: A 63-year-old man with chronic thrombocytopenia presented with new-onset seizures that progressed to coma. Cerebrospinal fluid (CSF) analysis showed Gram-negative rods, but CSF culture and the Biofire FilmArray Meningitis/Encephalitis Panel were negative. Additional 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction and sequencing of the CSF sample indicated E. coli meningitis when correlated with the results of urine culture. The patient eventually developed diffuse cerebral arterial vasospasms with multifocal brain infarcts that progressed to brain death. Conclusion E. coli meningitis in adults may be missed if diagnostic tests include only K1 strains. Clinicians should be aware of cerebral vasospasm as a potentially serious complication of E. coli meningitis, and should consider screening for it, particularly in patients with associated risk factors.

Background: Cerebral vasospasm has been reported following various forms of bacterial meningitis; however, there have been no prior reports of meningitis caused by the non-K1 strain of Escherichia coli. Case Report: A 63-year-old man with chronic thrombocytopenia presented with new-onset seizures that progressed to coma. Cerebrospinal fluid (CSF) analysis showed Gram-negative rods, but CSF culture and the Biofire FilmArray Meningitis/Encephalitis Panel were negative. Additional 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction and sequencing of the CSF sample indicated E. coli meningitis when correlated with the results of urine culture. The patient eventually developed diffuse cerebral arterial vasospasms with multifocal brain infarcts that progressed to brain death. Conclusion E. coli meningitis in adults may be missed if diagnostic tests include only K1 strains. Clinicians should be aware of cerebral vasospasm as a potentially serious complication of E. coli meningitis, and should consider screening for it, particularly in patients with associated risk factors.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory clinical syndrome of uncontrolled immune response which results in hypercytokinemia due to underlying primary or secondary immune defect. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only cure therapy for primary HLH and recurrent/refractory hemophagocytic lymphohistiocytosis. Compared with children HLH, adult HLH is a much more heterogeneous syndrome requiring a more individualized protocol depending on the underlying trigger, disease severity and genetic background. At present, there remain controversies in various aspects including indications of haematopoietic cell transplantation (HCT), conditioning regimen, efficacy and prognosis. This article will review the recent advances of allo-HSCT in the treatment of adult HLH based on the above issues.
Child ; Humans ; Adult ; Lymphohistiocytosis, Hemophagocytic/therapy* ; Hematopoietic Stem Cell Transplantation ; Transplantation Conditioning/methods*

OBJECTIVE: To investigate the efficacy, prognosis and safety of decitabine combined with modified EIAG regimen in the treatment of patients with relapsed/refractory acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). METHODS: The clinical data of 44 patients with relapsed/refractory AML and high-risk MDS admitted to our hospital from January 2017 to December 2020 were analyzed retrospectively. The patients were equally divided into D-EIAG group (decitabine combined with EIAG regimen) and D-CAG group (decitabine combined with CAG regimen) according to clinical treatment regimen. The complete response (CR), CR with incomplete hematologic recover (CRi), morphologic leukemia-free state (MLFS), partial response (PR), overall response rate (ORR), modified composite complete response (mCRc), overall survival (OS) time, 1-year OS rate, myelosuppression and adverse reactions between the two groups were compared. RESULTS: In D-EIAG group, 16 patients (72.7%) achieved mCRc (CR+CRi+MLFS), 3 patients (13.6%) achieved PR, and ORR (mCRc+PR) was 86.4%. In D-CAG group, 9 patients (40.9%) achieved mCRc, 6 patients (27.3%) achieved PR, and ORR was 68.2%. Difference was observed in mCRc rate between the two groups (P=0.035), but not in ORR (P>0.05). The median OS time of D-EIAG group and D-CAG group was 20 (2-38) months and 16 (3-32) months, and 1-year OS rate was 72.7% and 59.1%, respectively. There was no significant difference in 1-year OS rate between the two groups (P>0.05). After induction chemotherapy, the median time for absolute neutrophil count recovery to 0.5×10⁹/L in D-EIAG group and D-CAG group was 14 (10-27) d and 12 (10-26) d, for platelet count recovery to 20×10⁹/L was 15 (11-28) d and 14 (11-24)d, the median red blood cell suspension transfusion volume was 8 (6-12) U and 6 (6-12) U, and the median apheresis platelet transfusion volume was 4 (2-8) U and 3 (2-6) U, respectively. There were no statistically significant differences in comparison of the above indicators between the two groups (P>0.05). The hematological adverse reactions of patients were mainly myelosuppression. Grade III-IV hematological adverse events occurred in both groups (100%), with no increase in the incidence of non-hematological toxicities such as gastrointestinal reactions or liver function damage. CONCLUSION Decitabine combined with EIAG regimen in the treatment of relapsed/refractory AML and high-risk MDS can improve remission rate, provide an opportunity for subsequent therapies, and have no increase in adverse reactions compared with D-CAG regimen.
Humans ; Decitabine/therapeutic use* ; Treatment Outcome ; Retrospective Studies ; Cytarabine ; Myelodysplastic Syndromes/drug therapy* ; Leukemia, Myeloid, Acute/drug therapy* ; Bone Marrow Diseases/drug therapy* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use*

OBJECTIVE: To investigate the recovery characteristics of T cell subsets in patients with severe aplastic anemia (SAA) who received haploid hematopoietic stem cell transplantation(HSCT) and its relationship with acute graft-versus-host disease(aGVHD). METHODS: The clinical data of 29 SAA patients who received haploid hematopoietic stem cell transplantation in the department of hematology, Shanxi Bethune Hospital from June 2018 to January 2022 were retrospectively analyzed. The absolute counts of CD3⁺T, CD4⁺T, CD8⁺T lymphocytes and the ratio of CD4⁺T/CD8⁺T lymphocytes in all patients before transplantation, 14, 21, 30, 60, 90 and 120 days after transplantation were analyzed. The proportion of T lymphocytes was compared in the non-aGVHD group, the grade Ⅰ-Ⅱ aGVHD group and the grade III-IV aGVHD group. RESULTS: The counts of all T cells in 27 patients were far below the normal level at 14 and 21 days after transplantation, but there was obvious heterogeneity. There was a certain relationship between T cell immune reconstitution and conditioning regimen, age, and immunosuppressive treatment before transplantation. CD3⁺T cells showed a steady upward trend at 30, 60, 90, and 120 days after transplantation, and returned to the normal levels at 120 days after transplantation; faster recovery of CD4⁺T cells was closely related to aGVHD, which was at 30, 60, 90, 120 days after transplantation showed a slow upward trend, and which was still far below the normal level of 120 days after transplantation. CD8⁺T cell counts began to recover at 14 and 21 days after transplantation, and the recovery was earlier than the CD4⁺T cells, and its recovery speed was rapid 30 and 60 days after transptantation, which showed an upward trend and exceeded the normal levels 90 days after transplantation. Since CD8⁺ T cells reconstituted quickly, while the CD4⁺ T cells reconstitution was slowly, which made the long-term CD4⁺T/CD8⁺T cell ratio after transplantation was inverted . Compared with the non-aGVHD group, the absolute counts of CD3⁺T, CD4⁺T, and CD8⁺T cells in the aGVHD group were significantly higher than those in the non-aGVHD group at each time period after transplantation. In the aGVHD group, grade Ⅲ-Ⅳ aGVHD occurred more frequently in the early post-transplantation period (within 14-21 days), the grade Ⅰ-Ⅱ aGVHD group mostly occurred within 30-90 days after transplantation, and CD3⁺T, CD4⁺T, CD8⁺T cell counts in the grade Ⅲ-Ⅳ aGVHD group were significantly higher than those in the grade Ⅰ-Ⅱ aGVHD group; and the greater the proportion of CD4⁺T, the more severe the degree of aGVHD. CONCLUSION The speed of T cell immune reconstitution after SAA haploid transplantation is different, which is related to the conditioning regimen, age, and immunosuppressive therapy before transplantation. The rapid recovery of CD4⁺ T cells is closely related to the occurrence of aGVHD.
Humans ; Anemia, Aplastic/therapy* ; CD8-Positive T-Lymphocytes ; Retrospective Studies ; Haploidy ; Hematopoietic Stem Cell Transplantation ; Graft vs Host Disease

Transplantation-associated thrombotic microangiopathy (TA-TMA) is one of the serious complications mostly occurring within 100 days after hematopoietic stem cell transplantation (HSCT). Risk factors of TA-TMA include genetic predispositions, GVHD, and infections. The pathophysiological mechanisms of TA-TMA start with endothelial injury caused by complement activation, which leads to microvascular thrombosis, and microvascular hemolysis, ultimately resulting in multi-organ dysfunction. In recent years, the development of complement inhibitors has markedly improved the prognosis of TA-TMA patients. This review will give an update on risk factors, clinical manifestations, diagnosis, and treatment of TA-TMA, so as to provide references for clinical practice.
Humans ; Thrombotic Microangiopathies/therapy* ; Prognosis ; Thrombosis/etiology* ; Risk Factors ; Hematopoietic Stem Cell Transplantation/adverse effects*