Infectious Pulmonary Complications Research Articles

Analysis of Clinical Characteristics and Poor Prognostic Predictors in Patients With an Initial Diagnosis of Autoimmune Encephalitis

Purpose: We aimed to retrospectively analyze the clinical features, laboratory and imaging results, and predictors of poor prognosis for patients with an initial diagnosis of autoimmune encephalitis (AE) at the Affiliated Hospital of Zunyi Medical University.Methods: Fifty patients with an initial diagnosis of AE who were admitted to our hospital from May 2014 to May 2018 were enrolled retrospectively. Clinical characteristics and experimental test data, including the neutrophil-to-lymphocyte ratio (NLR), were collected from medical records within 24 h of admission. Independent prognostic factors were determined by multivariate logistic regression analysis. A good or poor prognosis for patients was defined based on the modified Rankin Scale (mRS). The correlation between the immunotherapy latency and prognostic mRS score was determined using the Spearman rank correlation test.Results: Univariate analysis indicated that increased NLR (P = 0.001), decreased lymphocyte counts (P = 0.001), low serum albumin (P = 0.017), consciousness disorders (P = 0.001), epileptic seizures (P = 0.007), extrapyramidal symptoms (P = 0.042), abnormal electroencephalogram (EEG) findings (P = 0.001), abnormal brain magnetic resonance imaging (MRI) findings (P = 0.003), and pulmonary infection complications (P = 0.000) were associated with the poor prognosis of AE. Multivariate logistic regression analysis showed that NLR (odds ratio [OR] 2.169, 95% confidence interval [CI] 1.029–4.570; P < 0.05) was an independent risk factor for predicting the poor prognosis of AE. NLR > 4.45 was suggested as the cut-off threshold for predicting the adverse outcomes of AE. In addition, we revealed that there was a positive correlation between immunotherapy latency and mRS score (rs = 0.535, P < 0.05).Conclusions: NLR may have predictive value for the poor outcomes of AE. Early initiation of immunotherapy is associated with a good prognosis.

Pulmonary Complications Following Hematopoietic Stem Cell Transplantation

Introduction Hematopoietic stem cell transplantation (HSCT) has been established as a therapeutic option for a wide variety of malignant and non-malignant pathologies. However, the outcome of HSCT is limited by several side effects, among which pulmonary toxicity stands out, with pulmonary complications that may be early or late and infectious or non-infectious. Given the morbidity and mortality associated with these events, the aim of the present study is to assess the prevalence of pulmonary complications in patients who underwent HSCT in a Colombian population. Methods An observational descriptive, ambispective study was conducted at a tertiary referral center in Colombia, South America, on patients who underwent HSCT between November/2009-April/2017. Pulmonary complications were assessed at 30, 31-100, and 101-365 days post-transplantation. The Kaplan-Meier method was used to assess overall survival at 1 year. Results A total of 191 HSCT were performed on 184 patients during the study period. Seventy-one patients were female. There were 141 autologous HSCT (auto-HSCT) and 50 allogeneic HSCT (allo-HSCT), mean age of 49.4 years and 31.8 years respectively. The cumulative incidence for pulmonary complications in the present cohort was 22.69% and density incidence of 30.8 per 10.000 persons-days. The cumulative incidence for pulmonary complication was 19.72% in auto-HSCT and 16.68% in allo-HSCT. The most common type of pulmonary complication was infectious for both auto- and allo-HSCT. Analyzing risk factors for infectious pulmonary complications in auto-HSCT, a Karnofsky score of 60 in the performance status scale showed a RR of 42 (CI95%:1.3-1268.8, p=0.03) 31-100 days post-transplantation. Analyzing risk factors for non-infectious complications in auto-HSCT, undergoing a second transplantation showed a RR of 26.7 (CI95%:1.45-492, p=0.027) at 30 days, RR of 13.3 (CI95%:1.02-172.2, p=0.048) 31-100 days, and RR of 6.2 (CI95%:1-38, p=0.049) 101-365 days post-transplantation. Overall survival for pulmonary complications after HSCT was 79.9% (CI95%:0.708-0.86) for auto-HSCT and 85.7% (CI95%:0.708-0.93) for allo-HSCT at 1 year. Conclusion The present cohort had a lower cumulative incidence for both infectious and non-infectious pulmonary complications post-HSCT than the reported in the literature.

Impact of blunt pulmonary contusion in polytrauma patients with rib fractures

BackgroundWe investigated the impact of blunt pulmonary contusion (BPC) in patients with rib fractures. MethodsAdult patients with rib fractures caused by blunt mechanisms were enrolled over 3 years at a Level 1 trauma center. BPC was defined according to percentage of lung affected as: moderate (1–19% contusion) or severe (≥20% contusion). ResultsIn total, 1448 of the 7238 admitted patients had rib fractures. Of these, 321 (22.2%) had BPC: 236 moderate and 85 severe. Patients with BPC were more likely to be admitted to the ICU (moderate: OR 1.55, 95% CI 1.10–2.19; severe: OR 2.74, 95% CI 1.41–5.32). Significantly increased rates of pneumonia (OR 2.52, 95% CI 1.43–4.90) and empyema (OR 4.80, 95% CI 1.07–21.54) were found for moderate and severe BPC, respectively. ConclusionsICU admission and infectious pulmonary complications were more likely with BPC. The presence of BPC on admission CT is also prognostic of increased resource utilization.

Pulmonary infectious complications after hematopoietic stem cell transplantation: a practical guide to clinicians.

The current review highlights the most relevant articles on lung infections following hematopoietic stem cell transplantation (HCT) published over the last year. Between 30 and 50% of HCT recipients will develop pulmonary infiltrates. These pulmonary complications may be infectious (caused by virus, bacteria, fungi, or protozoa) or noninfectious (e.g., fluid overload, heart failure, transfusion reactions like transfusion associated lung injury and transfusion-associated circulatory overload, drug reactions, engraftment syndrome, idiopathic pneumonia syndrome, diffuse alveolar hemorrhage, cryptogenic organizing pneumonia, and bronchiolitis obliterans syndrome). New data on the yield of bronchoscopy and bronchoalveolar lavage (BAL), the prevalence and clinical manifestations of respiratory viruses and the usefulness of molecular techniques for diagnosis have been published. In addition, guidelines or meta-analyses on the management of neutropenic fever, serological diagnosis of fungal infections and diagnosis and management of Pneumocystis and aspergillosis have been published. Respiratory viruses are important pathogens after HCT. PCR in the BAL is becoming the diagnostic modality of choice for a variety of infections. The best approach for the empirical management of pulmonary infiltrates following HCT remains to be defined.

IMAGING OF INFECTIOUS PULMONARY COMPLICATIONS IN PATIENTS WITH HEMATOLOGIC MALIGNANCIES

Radiological imaging is the main diagnostic technique of infectious pulmonary complications in patients with hematological malignancy. Disturbance of the immune system in this group of patients causes uncommon epidemiology, nonspecific clinical manifestation and rapidly progressive development of the infectious process. Modern diagnostic methods allow to reveal inflammatory changes in the lungs with high efficiency. In the current clinical practice, the most actual problem is rapid identification of pathogens using the wide-spread method. This possibility results in faster and more accurate patient treatment. The article reviews different imaging techniques and focuses on the preferable method for diagnosing pneumonia in immunocompromised patients and presents a recent view of russian and foreign researchers on the advantages and limitations of computed tomography in the differential diagnosis of lower respiratory tract infections.

Acute Graft-Versus-Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Introduction Acute GVHD is one of the most common serious complications of allogeneic HSCT and remains a leading cause of mortality in HSCT recipients all over the world. Various publications showed the association of acute GVHD with higher risk of infectious complications. There is lack of data on risk factors for developing an episode of infection and spectrum of infections in patients with acute GVHD after allogeneic HSCT. Objective to determine the risk factors and spectrum of infectious complications in patients with acute GVHD after allogeneic HSCT. Methods An ambispective observational study was performed to evaluate the risk factors and characteristics of infectious complications in adult patients having acute GVHD after HSCT. Proven case of infection (bacterial, viral or fungal) was taken as a primary outcome in the study. There were totally 68 adult patients with II-IV grades of acute GVHD after allogeneic HSCT included in the study. As a covariates included in multivariate analysis were taken: procedure of MCSs transplantation; type of allogeneic HSCT (related/non-related), main disease progression, absolute neutrophil count (ANC) on the first day of infectious complication, GVHD-involved organs. Results Microbiological data concerning the causes of infectious complications in patients with acute GVHD has shown the major impact of viral infections (CMV) and invasive pulmonary aspergillosis. There were no bloodstream infections caused by Candida spp. registered in the study. Bacterial infections were mostly presented by bloodstream infections (caused by K. pneumoniae, E. faecalis, E. coli) and pneumonia. Progression of main disease (OR 5.52; 95% CI 1.21-25.06; p=0.0270) was found to be an independent risk factor for development of invasive pulmonary aspergillosis and bacterial infectious complications. Patients with hematopoietic stem cell transplant from unrelated donor remain in a group with high risk for bacterial infections in case of developing acute GVHD (OR 3.50; 95% CI 1.12-10.97; p=0.0316). The procedure of MSCs transplantation as a potential treatment of GVHD showed no influence on risk of invasive aspergillosis (OR 3.25; 95% CI 0.64-16.47; p=0.1536) or CMV-reactivation (reciprocal OR 0.42; 95% CI 0.12-1.49; p=0.1802) in the study. Conclusion Among the most frequent infections in acute GVHD we have described CMV, invasive aspergillosis and bacterial infections. Among risk factors for infectious complications in patients with acute GVHD are progression of main disease and neutropenia below 500 cells/mm3 (for aspergillosis) and unrelated HSCT in the past history and progression of main disease (for bacterial bloodstream infections and pneumonia). MSCs transplantation as a treatment strategy for acute GVHD has shown no statistically significant association with risk of infectious complications in a performed multivariate analysis.

Specific features of respiratory and intensive therapy for pulmonary infectious complications of acute and chronic kidney graft rejection

The purpose was to determine the specific features of respiratory and intensive therapy of pulmonary infectious complications in acute and chronic kidney graft rejection. Material and methods. The results of treatment of 7 patients with pulmonary infectious complications against an acute and chronic kidney graft rejection were retrospectively studied. Results. The total number of pulmonary infection cases made 7 among 54 cases of kidney transplantation from living related donors. In all cases, bilateral interstitial pneumonia was diagnosed. Six patients had positive dynamics on receiving a respiratory therapy and intensive care.

RISK OF DEVELOPING ACTIVE TB IN IBD PATIENTS TREATED WITH ATNI-TNF

AIM. To develop an investigation complex for IBD-patients with the anti-TNF therapy to decrease the risk of active TB. METHODS. In Moscow Research and Clinical Center for TB Control 454 patients with IBD were screened prior to initiation of anti-TNF treatment and 167 (36,8%) of them - during the anti-TNF therapy. Tuberculin skin test (TST) and chest radiography were used for screening and evaluation of pulmonary adverse effects (every 6 months and additionally in cases of any respiratory signs). RESULTS. Of 454 patients investigated during screening X-ray, chest radiography findings were detected in 29 (6,4%), which required additional investigation, among them in 14 patients, findings considered as residual TB lesions. In the other 15 patients, the radiographic findings caused by previous non-specific pulmonary infections. Positive TST implicates preventive antituberculosis therapy, which was provided 37 patients (before and under anti-TNF therapy). During provided to 167 patients the anti-TNF therapy, were developed pulmonary adverse effects: 10 incidences of active TB lung infection 3 case of sarcoidosis, 1 case of fibrosing alveolitis, and two case of non-CONCLUSION. The patients with IBD, treated by anti-TNF therapy, have a risk of development of a wide variety of infectious and non-infectious pulmonary complications, including TB. It is therefore highly important to carefully monitor the patients prior and during the anti-TNF therapy (every 6 months) for a timely detection of pulmonary conditions potentially associated with the treatment.

Low TT4 as a predictor of poor outcomes in severe encephalitis: a multivariate analysis of 94 patients

ABSTRACTBackground: To investigate the prognostic value of acute thyroid function in patients with severe encephalitis.Methods: We retrospectively analyzed information from patients with severe encephalitis from June 2012 to June 2017. Using multivariate logistic regression analysis, we examined predictors of poor outcomes in these patients after 6 months.Results: A total of 94 patients with severe encephalitis were included in the study. Univariate analysis showed that patients with good or poor outcomes had significantly different total thyroxine (TT4) (P = 0.012) and free triiodothyronine (FT3) (P = 0.049) levels, mechanical ventilation requirements (P < 0.001), pulmonary infection complications (P = 0.001), lengths of neurological intensive care unit (P = 0.003) and total hospital (P = 0.012) stay, and Acute Physiology and Chronic Health Evaluation (APACHE II) (P = 0.005) and Glasgow Coma Scale (GCS) (P = 0) scores. The results of multivariate analysis suggested the following factors to be associated with a poor outcome: a low TT4 level (OR 0.303, 95% CI 0.100–0.923) and a low GCS score (OR 0.683, 95% CI 0.506–0.923).Conclusions: Low TT4 has a predictive value for the adverse outcomes of severe encephalitis; further study is needed for verification.

Infectious and Non-infectious Pulmonary Complications of Primary Immunodeficiency Diseases in the USIDNET Registry

Infectious and Non-infectious Pulmonary Complications of Primary Immunodeficiency Diseases in the USIDNET Registry

Postoperative Complications Drive Unplanned Readmissions After Esophagectomy for Cancer

Hospital readmissions are increasingly viewed as a marker of inferior health care quality and penalized with decreased reimbursement. The timing of, and reasons for, readmissions after esophagectomy for cancer are not well understood. We examined the association of complications to 30-day postoperative-related, unplanned readmission to identify opportunities for improvement in patient care. We analyzed the American College of Surgeons National Surgical Quality Improvement Program database (2012 to 2015) to characterize 30-day postoperative unplanned readmissions after esophagectomy for cancer using descriptive statistics. Type and timing of readmission after discharge was assessed. A Cox proportional hazards model was developed to identify predictors of readmission. Of 3,723 patients who underwent esophagectomy for cancer, 1,419 (38.1%) experienced ≥1 complication within 30 days. A total of 400 patients (10.7%) experienced related, unplanned readmissions within 30 days of the operation, and postoperative complications were documented in 263 (65.8%). Leading causes of readmission were infectious, pulmonary, and gastrointestinal complications. Of these patients, 155 (59%) were readmitted within 7 days and 236 (90%) within 14 days of discharge. The Cox proportional hazards model identified readmission being associated with occurrence of postdischarge infectious, pulmonary, venous thromboembolic, and urinary tract infection complications, in-hospital urinary tract infection complications, and log-transformation of length of stay (representing increasing length of stay) (all p < 0.05). Postoperative occurrence of common complications and prolonged length of stay are associated with unplanned readmission after esophagectomy. Most patients are readmitted within 1 week of discharge. Earlier follow-up after discharge may identify patients with complications and facilitate outpatient intervention to prevent readmission.

Necrotising pneumonia caused by non-PVL Staphylococcus aureus with 2-year follow-up

Necrotising pneumonia (NP) is a rare but life-threatening complication of pulmonary infection. It is characterised by progressive necrosis of lung parenchyma with cavitating foci evident upon radiological investigation. This article...

Transbronchial biopsy in the management of pulmonary complications of hematopoietic stem cell transplantation.

The utility of transbronchial biopsy in the management of pulmonary complications following hematopoietic stem cell transplantation has shown variable results. Herein, we examine the largest case series of patients undergoing transbronchial biopsy following hematopoietic stem cell transplantation. We performed a retrospective analysis of 130 transbronchial biopsy cases performed in patients with pulmonary complications post-hematopoietic stem cell transplantation. Logistic regression models were applied to examine diagnostic yield, odds of therapy change and complications. The most common histologic finding on transbronchial biopsy was a non-specific interstitial pneumonitis (n= 24 cases, 18%). Pathogens identified by transbronchial biopsy were rare, occurring in < 5% of cases. A positive transbronchial biopsy significantly increased the odds of a subsequent change in corticosteroid therapy (OR=3.12, 95% CI 1.18–8.23; p=0.02) but was not associated with a change in antibiotic therapy (OR=1.01, 95% CI 0.40–2.54; p=0.98) or changes in overall therapy (OR=1.92, 95% CI 0.79–4.70; p=0.15). Patients who underwent a transbronchial biopsy had increased odds of complications related to the bronchoscopy (OR=3.33, 95% CI 1.63–6.79; p=0.001). In conclusion, transbronchial biopsy may contribute to the diagnostic management of non-infectious lung injury post-hematopoietic stem cell transplantation, while its utility in the management of infectious pulmonary complications of HSCT remains low.

Lipid-lowering agent-triggered dermatomyositis and polymyositis: a case series and literature review.

Lipid-lowering agent-triggered dermatomyositis (DM) or polymyositis (PM) is a rare event. Therefore, the aim of the present study was to describe a series of such cases. A retrospective cohort study of 5 DM and 4 PM cases triggered by prior exposure to lipid-lowering agents between 2001 and 2017 was carried out. All patients, except for two cases, had muscle biopsy compatible with inflammatory myopathy and no serum autoantibodies positive for anti-SRP or anti-HMGCoAR. Median age of the patients at time of diagnosis was 68years. Seven patients had previously taken simvastatin 20mg/day (exposure period from 2days to 4years) and two bezafibrate 100mg/day (3-4months). Median time from symptom onset to disease diagnosis was 6months. All patients with DM had a heliotrope and/or Gottron's papules. All patients had symmetrical, predominantly proximal muscle weakness of limbs, with median serum creatine phosphokinase of 3087U/L (interquartile 25-75% range 1293-13,937U/L). All patients received glucocorticoid and immunosuppressants. Complete reversal of clinical symptoms and normalization of serum creatine phosphokinase level occurred within a median of 12months after starting the treatment. There was disease relapse in three cases, and one case of death was unrelated to the disease (pulmonary infectious complications resulting from lymphoma). In contrast to cases described in the literature, the patients in the present study had a relatively more aggressive course, requiring glucocorticoids and immunosuppressants, in addition to a tendency for a longer period to achieve disease remission.

Analysis of risk factors for post-operative complications and prognostic predictors of disease recurrence following definitive treatment of patients with esophageal cancer from two medical centers in Northwest China.

Evaluating the clinicopathological features of patients receiving definitive treatment for esophageal cancer may facilitate the identification of patterns and factors associated with post-operative complications, and enable the development of a surveillance strategy for surviving patients at a higher risk of disease recurrence. In the present study, clinical data from 579 patients with esophageal cancer that underwent radical resection of esophagus were collected. These patients were admitted to two medical centers in Northwest China, and information regarding the presence or absence of basic chronic diseases and post-operative results were retrospectively analyzed. The level of selected stem cell markers, including aldehyde dehydrogenase 1, CD133, integrin subunit α 6, integrin subunit β 4 and T-cell factor-4, were determined in esophageal cancer tissue samples in order to determine whether these markers may be useful predictors of disease prognosis and recurrence. Post-operative complications in patients receiving radical resection of the esophagus included respiratory system complications, cardiovascular abnormalities and esophageal anastomotic fistulae. Diabetes, basic respiratory disease and lower pre-surgical serum albumin levels were observed to be individual risk factors associated with post-operative complications, including respiratory system complications of acute respiratory failure and pulmonary infection, cardiovascular abnormalities of atrial fibrillation and arrhythmia, as well as the development of esophageal anastomotic fistulae. Diagnosis of esophageal cancer at later stage was significantly correlated with anastomotic fistula. Molecular detection of stem cell markers for prognosis prediction was achieved by immunohistochemical and immunofluorescence staining assays. The results demonstrated that the presence of stem-like cells in cancer tissues was associated with poor disease prognosis and a high recurrence ratio. In conclusion, the results of the current study suggested that post-operative complications were more likely to occur in patients with diabetes, basic respiratory disease or lower serum albumin levels prior to surgery. Therefore, sufficient intensive peri-operative care, rigorous operative risk assessments, and the selection of the patients with early or mid-stage esophageal cancer, may decrease the risk of post-surgical complications in patients receiving radical resection of the esophagus. In addition, a high ratio of esophageal cancer stem-like cells was associated with cancer recurrence. These results suggest that an intensive surveillance strategy should be implemented in order to facilitate early detection of disease recurrence and improve the clinical management of these patients post-surgery.

СОВРЕМЕННОЕ СОСТОЯНИЕ И ПЕРСПЕКТИВЫ ДИАГНОСТИКИ НОЗОКОМИАЛЬНОЙ ПНЕВМОНИИ У ПОСТРАДАВШИХ ПРИ ПОЛИТРАВМЕ

Trauma injuries account for high mortality and disability in the cohort of the employable population. Pulmonary infectious complications in those injured with multiple traumas contribute the most to mortality of such patients. The article describes risk factors, causative agents, pathologic physiology and specific features of diagnostics of nosocomial pneumonia in those with multiple traumas. Special attention is paid to study of state and variants of the immune response to multiple trauma and related issues on using polymorphism of genes controlling the release of certain cytokines in order to improve diagnostics and prognosis of the course and outcome of nosocomial pneumonia in this group of patients.

The clinical impact of artery-first approach combined with vascular resection and reconstruction in the treatment of pancreatic head carcinoma

Objective: To evaluate the application of artery first, combined vascular resection and reconstruction in the treatment of pancreatic head carcinoma. Methods: The clinical data of 13 patients with pancreatic head cancer were retrospectively analyzed from February 2014 to March 2016 in the Affiliated Hospital of Xiamen University. Preoperative computed tomography of high resolution layer or magnetic resonance imaging examination demonstrated pancreatic head carcinoma, as well as close adhesion, stenosis, compression or displacement of superior mesenteric vein or portal vein wall. In the operation, the artery first approach was used and the whole arterial blood supply in the head of the pancreas was fully exposed and interdicted. Finally, en block resection and vascular resection and reconstruction was adopted. Results: 12 of 13 patients had pancreatoduodenectomy synchronously with vascular resection and reconstruction; the other patient had these two surgery sequentially. Four patients received blood vessel wedge resection, five had segmental resection combined with end to end suture, and four had segmental resection combined with artificial vascular graft reconstruction. Operation time was (327.2±65.5) minutes, and the amount of blood loss was (472.6±226.4) millilitres. One patient suffered from delayed gastric emptying, and two patients had pancreatic fistula. All patients recovered from postoperative complications by conservative treatment. No patients developed biliary fistula, gastrointestinal fistula, abdominal infection, pulmonary infection, diarrhea, hypoglycemia or other complications, and none died in perioperative period. Postoperative pathological findings confirmed the diagnosis of pancreatic ductal adenocarcinoma. Mean tumor diameter was (4.2±1.5)cm, and (3.8±1.5) metastasis were found in (13.6±2.5) resected lymph nodes. In 11 cases, the tumor cells were found in the outer membrane of blood vessels, 2 cases were found to have tumor invasion in the inner membrane, and all the resection margins were negative. All patients were followed up, and 2 patients died of liver metastasis 11 months and 18 months after operation, respectively. One patient survived with local recurrence of tumor 13 months after surgery. Other patients had no tumor recurrence and metastasis. Conclusions: The artery first approch combined vascular resection and reconstruction is safe effective and feasible in the treatment of pancreatic head carcinoma. It can improve the ablation rate of pancreatoduodenectomy.

Short-term outcomes of lung transplant recipients using organs from brain death donors

Objective: To assess short-term outcomes after lung transplantation with organs procured following brain death. Methods: Between April 2015 and July 2016, all 17 recipients after lung transplantation using organs from brain death donors (DBD) at Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine were enrolled in this study. All patients were male, aging (60±7) years, including 11 chronic obstructive pulmonary disease, 5 idiopathic pulmonary fibrosis, 1 silicosis. Seventeen donors were 16 males and 1 female, with 10 traumatic brain injury, 5 cerebrovascular accident and 2 sudden cardiac death. Of 17 recipients receiving DBD lung transplant, 16 were single lung transplant. Data were collected including intubation duration of mechanical ventilation, hospital length of stay, incidence of pulmonary infection bronchus anastomosis complications, primary graft dysfunction (PGD), and acute rejection, bronchiolitis obliterans syndrome (BOS) as well as mortality of 90-day after lung transplantation. Results: Median duration of intubation were 2 (2) days (M(QR)) in recipients after lung transplantation. The incidence of pulmonary infection and bronchus anastomosis complications were 15/17 and 5/17, respectively. Median length of stay in hospital were 56 (19) days. The ratio of readmission 1 month after discharge were 10/17. Mortality of 90-day post-transplant were 2/17. The incidence of PGD and BOS were 1/17 and 2/17, respectively. Conclusion: Recipients with DBD lung transplantation have an acceptable survival during short-term follow-up, but with higher incidences of complications related to infection post-transplantation.

Spleen Histologic Appearance in Common Variable Immunodeficiency: Analysis of 17 Cases.

Histologic and phenotypic analyses of splenectomy samples from 17 patients with common variable immunodeficiency (CVID) showed the following nonspecific, evocative, white-pulp lesions: white-pulp hyperplasia (WPH) with reactive follicles, giant follicles (GFs), marginal zone hyperplasia, periarteriolar T-zone hyperplasia (PATH) and/or granulomas, which enabled us to discern 2 groups: the first (n=6) composed of WPH with reactive follicles without granulomas, and the second (n=9) characterized by the presence of granulomas with or without WPH. All specimens were Epstein-Barr virus negative by in situ hybridization. Molecular analyses revealed a polyclonal immunoglobulin heavy chain gene (IGH) rearrangement (n=12). WPH-only patients were mostly female individuals and younger at CVID onset, diagnosis, and splenectomy, but their interval between the first symptom and diagnosis was longer; they had more associated infectious events, autoimmune disease, pulmonary complications, and liver regenerative nodular hyperplasia; their IgG, IgA, and IgM concentrations were also higher. Granuloma-group patients were mostly male individuals; were older at CVID onset, diagnosis, and splenectomy; had disseminated granulomatous disease, but infectious events, autoimmune disease, pulmonary complications, and liver regenerative nodular hyperplasia were less common; their immunoglobulin concentrations were lower. Histologic comparisons between the WPH-only and granuloma groups showed more intense WPH and more intense marginal zone hyperplasia and fewer GFs in the former versus more developed PATH and more common GFs in the latter. The results of this novel comparative study of the histologic patterns of 17 CVID patients' evocative splenic lesions suggested different biological and clinical profiles.

Clinical Summarization of Allogeneic Hematopoietic Stem Cell Transplantation for Leukemia: A Report of 100 Cases

To analyze the treatment outcome of a consecutive series of 100 leukemia patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT). The clinical data of leukemia patients received allo-HSCT were analyzed retrospectively, the therapeutic efficacy was summarized. 100 evaluable cases of leukemia included 47 cases of AML, 33 cases of ALL, 2 cases of AL (biphenotypic), 16 CML and 2 CMML. Before transplantation, 76 cases were in first complete remission, 9 cases in second or greater complete remission and 15 cases in non-remission or relapse. All the patients received peripheral blood hematopoietic stem cell transplantation (PBHSCT). The conditioning regimen of human leukocyte antigen (HLA)-matched allo-HSCT group was modified BuCy, but in HLA-mismatched group Fludarabine and anti-human thymocyte globulin (ATG) was added. CsA+MTX regimen was used for prophylaxis of graft-versus-host disease (GVHD) in HLA-identical allo-HSCT, while additional MMF was added in HLA-mismatched group. The average time of follow-up was 13 months. At the last follow-up, 66.0% (66/100) patients survived, 53.0% (53/100) patients survived without leukemia, 28.0% (28/100) patients relapsed and 34.0% (34/100) patients died, 44.1% patients of them died from infectious pulmonary complications. During transplantation, 65.0% of the patients were suffered from lung infection. The overall survival (OS) and disease-free survival (DFS) of all cases was 60.9% and 48.8%, respectively. The recurrence rate was significantly higher in non-remission (66.7%) than in CR (21.2%) patients (P < 0.05). The cumulative incidence of GVHD in HLA-mismatched transplantation was 60.8%, which was significantly higher than that of HLA-matched transplantation (38.8%) (P < 0.05). Allo-HSCT can cure a significant proportion of leukemia patients, especially for those in CR status. Since the incidence of infectious pulmonary complications after allo-HSCT is still high, much more attention should be paid to it. The comprehensive prognosis of HLA-matched transplantation is better than the HLA-mis-matched transplantation.