A 38-year-old male patient with ankylosing spondylitis received subcutaneous injection of adalimumab 40 mg once every 2 weeks. After 21 months of medication, the patient developed fever, fatigue, swelling, and pain in the right neck lymph node and throat. Laboratory tests showed that the tuberculin test was strong positive, mycobacterium tuberculosis γ-interferon release test was 1 911.98 ng/L, and erythrocyte sedimentation rate was 27 mm/1 h. The biopsy of right neck lymph node showed granulomatous inflammation of the lymph node. The patient was diagnosed with cervical lymph node tuberculosis, which was considered to be related to adalimumab. The drug was stopped and anti-tuberculosis treatments were given. The next day, the patient′s temperature returned to normal. After 5 days, the swelling and pain of cervical lymph nodes and throat, and the fatigue were relieved gradually. After 45 days, the above symptoms in the patient disappeared.

Background: Inflammation indices are emerging predictors of diseases. Monoclonal gammopathy of undetermined significance (MGUS) is a precancerous state and chronic inflammation may drive MGUS progression. This study aimed to evaluate the association between inflammatory markers and MGUS. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) III and 1999–2004 were collected from 6,383 participants. MGUS subtypes were identified using immunofixation electrophoresis. Seven inflammatory indices [lymphocyte count (LC), neutrophil count (NC), platelet-neutrophil product (PPN), systemic immune inflammation index (SII), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP)] were calculated. Weighted multivariate regression and subgroup analyses assessed the relationships, reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results: Of the 6383 patients included in the study, 157 (2.45%) underwent MGUS. There was a significant correlation trend between ln PPN level and the development of MGUS, especially at low levels (OR: 2.62, 95% CI: 1.54–4.75, p-trend = 0.001), while the correlation between PLR level and MGUS was not obvious. In the subgroup analysis, a significant association between PPN level and MGUS was mainly found in the overall population, female sex, nonHispanic black, non-hypercholesterolemia, non-type 2 diabetes (T2D), high school education or above, and divorced or widowed; however, there was no significant interaction between PPN level and MGUS in each subgroup. Conclusion PPN levels were significantly associated with MGUS development. Our study identified PPN as a novel and convenient inflammatory marker with potential clinical relevance. Although preliminary, the observed associations highlight the need for validation through longitudinal studies before considering their clinical applications.

A 38-year-old male patient with ankylosing spondylitis received subcutaneous injection of adalimumab 40 mg once every 2 weeks. After 21 months of medication, the patient developed fever, fatigue, swelling, and pain in the right neck lymph node and throat. Laboratory tests showed that the tuberculin test was strong positive, mycobacterium tuberculosis γ-interferon release test was 1 911.98 ng/L, and erythrocyte sedimentation rate was 27 mm/1 h. The biopsy of right neck lymph node showed granulomatous inflammation of the lymph node. The patient was diagnosed with cervical lymph node tuberculosis, which was considered to be related to adalimumab. The drug was stopped and anti-tuberculosis treatments were given. The next day, the patient′s temperature returned to normal. After 5 days, the swelling and pain of cervical lymph nodes and throat, and the fatigue were relieved gradually. After 45 days, the above symptoms in the patient disappeared.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.

Objective To investigate the pharmacological effects of"Yajieshaba"on mice with alcohol-induced liver injury and to investigate the mechanism of the impact of"Yajieshaba"on the regulation of intestinal flora by 16S rDNA technology.Methods Healthy male KM mice were randomly divided into control,model,"Yajieshaba"low,medium,and high dose(0.39,1.17 and 3.51 g·kg-1)groups and Bifendatatum(2.93 mg·kg-1)groups,with eight mice in each group.After one week of pre-administration of"Yajieshaba",a mouse model of acute alcoholic liver injury was established by a single instillation of 56%alcohol,and the levels of AST and ALT in the serum of mice were measured,and the morphological changes of liver histology were observed by HE staining;secondly,faecal DNA was extracted from each group under aseptic operation,and 16S rDNA sequencing and differential analysis by alpha diversity and species composition at the phylum and genus levels were performed.Results The results showed that the biochemical indexes of liver function(ALT and AST)were significantly improved by"Yajieshaba",and the degree of liver damage was significantly reduced by HE staining.At the phylum level,it significantly decreased the abundance of Aspergillus and increased the quantity of Bacteroides;at the genus level,it significantly up-regulated the plenty of Bacteroides and Prevotella and downregulated a lot of Prevotella and Helicobacter.At the genus level,"Yajieshaba"significantly up-regulated the abundance of Bacillus spp.and Prevotella spp.and down-regulated the abundance of Prevotella spp.and Helicobacter spp.Conclusion"Yajieshaba"may play an anti-acute alcoholic liver injury effect by regulating the intestinal flora and metabolites.

Objective To analyze the clinicopathological features,treatment and prognosis of patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposition.Methods The clinical data,renal pathology,treatment and prognosis of patients with PGNMID diagnosed by renal biopsy in Xijing Hospital from January 2018 to January 2024 were retrospectively analyzed and summarized.Results A total of 28 patients were enrolled in this study,with a male to female ratio of 4:3.The clinical manifestations were proteinuria(100%),hematuria(82.1%),renal insufficiency(28.6%),and low complement C3 or C4 emia(32.1%).One patient(3.6%)had serum monoclonal immunoglobulin,and 5 patients(17.9%)had abnormal serum free light chain ratio.The deposition of immunoglobulin in the kidney was IgG3 in 24 cases,IgG1 in 4 cases,and IgG3κwas the most common type(17 cases).Then there are 24 cases(85.7%)of MPGN,3 cases(10.7%)characterized by EPGN,1 case(3.6%)of MGN.Under electron microscope,most of the electron-dense deposits were found in the mesangial area and subendothelium,and a few were accompanied by subepithelial deposits.The follow-up time ranged from 3 to 56 months.Until the last follow-up,a total of 5 patients entered ESRD,of which 2 patients died,1 patient underwent peritoneal dialysis,1 patient underwent hemodialysis,and 1 patient underwent preparation for renal replacement therapy.Follow-up of 1 year,2 years,3 years renal total response rate of 32.1%,57.1%and 64.2%respectively.According to the situation of kidney ease into remission group(n=16)and non-remission group(n=12).The average age of the remission group was 44±17.35 years,including 8 males(50%);The average age of the non-remission group was 59.83±18.09 years,including 8 males(66.7%).The age,nT-proBNP,troponin I and urea nitrogen of the non-remission group were higher than those of the remission group,and the differences were statistically significant(P＜0.05).Among the 5 patients with renal complete remission,2 were treated with BD(bortezomib combined with dexamethasone),1 was treated with Dara,and the remaining 2 were treated with steroids combined with immunosuppressants.Conclusions The clinical manifestations of PGNMID are proteinuria,hematuria and renal insufficiency.Under light microscope,MPGN was the main manifestation,and IgG3κwas the most common subtype.Based on bortezomib treatment can obtain good hematology and kidney remission rate.Dara may be a safe and effective drug for the treatment of PGNMID,the best treatment needs further exploration.

Objective To analyze the clinicopathological features,treatment and prognosis of patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposition.Methods The clinical data,renal pathology,treatment and prognosis of patients with PGNMID diagnosed by renal biopsy in Xijing Hospital from January 2018 to January 2024 were retrospectively analyzed and summarized.Results A total of 28 patients were enrolled in this study,with a male to female ratio of 4:3.The clinical manifestations were proteinuria(100%),hematuria(82.1%),renal insufficiency(28.6%),and low complement C3 or C4 emia(32.1%).One patient(3.6%)had serum monoclonal immunoglobulin,and 5 patients(17.9%)had abnormal serum free light chain ratio.The deposition of immunoglobulin in the kidney was IgG3 in 24 cases,IgG1 in 4 cases,and IgG3κwas the most common type(17 cases).Then there are 24 cases(85.7%)of MPGN,3 cases(10.7%)characterized by EPGN,1 case(3.6%)of MGN.Under electron microscope,most of the electron-dense deposits were found in the mesangial area and subendothelium,and a few were accompanied by subepithelial deposits.The follow-up time ranged from 3 to 56 months.Until the last follow-up,a total of 5 patients entered ESRD,of which 2 patients died,1 patient underwent peritoneal dialysis,1 patient underwent hemodialysis,and 1 patient underwent preparation for renal replacement therapy.Follow-up of 1 year,2 years,3 years renal total response rate of 32.1%,57.1%and 64.2%respectively.According to the situation of kidney ease into remission group(n=16)and non-remission group(n=12).The average age of the remission group was 44±17.35 years,including 8 males(50%);The average age of the non-remission group was 59.83±18.09 years,including 8 males(66.7%).The age,nT-proBNP,troponin I and urea nitrogen of the non-remission group were higher than those of the remission group,and the differences were statistically significant(P＜0.05).Among the 5 patients with renal complete remission,2 were treated with BD(bortezomib combined with dexamethasone),1 was treated with Dara,and the remaining 2 were treated with steroids combined with immunosuppressants.Conclusions The clinical manifestations of PGNMID are proteinuria,hematuria and renal insufficiency.Under light microscope,MPGN was the main manifestation,and IgG3κwas the most common subtype.Based on bortezomib treatment can obtain good hematology and kidney remission rate.Dara may be a safe and effective drug for the treatment of PGNMID,the best treatment needs further exploration.

A 34-year-old male patient received a subcutaneous injection of 300 mg of secukinumab once a week for 5 times, subsequently 300 mg once every 4 weeks for 3 times because of psoriasis. Then the patient developed bloody purulent stool. Electronic colonoscopy revealed diffuse mucosal congestion and edema in the sigmoid colon at a distance of 25 cm from the anus. The pathological examination results of tissue biopsy showed severe chronic inflammation, erosion, and shallow ulcer formationin the sigmoid colon. Inflammatory bowel disease caused by secukinumab was considered. Then the drug was stopped, and mesalazine enema solution 60 g once daily was given. After half a month of treatment, the patient′s bloody purulent stool was improved significantly, and after 2 months, it disappeared. Electronic colonoscopy showed that the mucosa of the sigmoid colon was rough, granular, and scattered with small patches of bleeding at a distance of 20 cm to 25 cm from the anus, which was diagnosed as having ulcerative colitis (in remission). Mesalazine enema was discontinued and changed to mesalazine suppository 0.5 g once daily.

A 34-year-old male patient received a subcutaneous injection of 300 mg of secukinumab once a week for 5 times, subsequently 300 mg once every 4 weeks for 3 times because of psoriasis. Then the patient developed bloody purulent stool. Electronic colonoscopy revealed diffuse mucosal congestion and edema in the sigmoid colon at a distance of 25 cm from the anus. The pathological examination results of tissue biopsy showed severe chronic inflammation, erosion, and shallow ulcer formationin the sigmoid colon. Inflammatory bowel disease caused by secukinumab was considered. Then the drug was stopped, and mesalazine enema solution 60 g once daily was given. After half a month of treatment, the patient′s bloody purulent stool was improved significantly, and after 2 months, it disappeared. Electronic colonoscopy showed that the mucosa of the sigmoid colon was rough, granular, and scattered with small patches of bleeding at a distance of 20 cm to 25 cm from the anus, which was diagnosed as having ulcerative colitis (in remission). Mesalazine enema was discontinued and changed to mesalazine suppository 0.5 g once daily.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.