ObjectiveTo evaluate the relationship between CT lesion changes in COVID-19 patients and different subgroups of T lymphocytes, providing reference information for assessing patient conditions, predicting outcomes, and evaluating treatment efficacy. MethodsClinical and imaging data of confirmed COVID-19 patients admitted to the Chongqing Public Health Medical Center from January 24 to March 15, 2020, were collected. Based on the absorption characteristics of lesions in CT images, patients were categorized into three groups: Group A (obviously continuously absorbed), Group B (stable-slow absorption), and Group C (progressive absorption). The relationship between CT changes and T lymphocyte subgroups was analyzed according to lesion absorption. ResultsA total of 47 patients were included, with 18 in Group A, 14 in Group B, and 15 in Group C. At different stages—admission, during treatment, and at the end of treatment—the levels of T lymphocytes were observed as follows: Group A>Group B>Group C. When lesions were absorbed, the average count of CD4+ T lymphocytes was (544.43 ± 163.34) cells/μl; when lesions showed little change or increased, CD4+ T lymphocyte levels decreased to varying degrees. During treatment, both Group A and Group B showed CD4+ T lymphocyte levels returning to above normal levels, with an average increase of 134 cells/μl in Group A, which was lower than that in Group B (192 cells/μl) and Group C (149 cells/μl). Finally, T lymphocyte levels reached normal in all groups, but Group A levels were higher than those in Groups B and C (P<0.05). Upon follow-up, the average CD4+ T lymphocyte count was (544.43 ± 163.34) cells/μl in 52 cases of lesion absorption, (339.06 ± 145.98) cells/μl in 31 cases of minimal change, and (230.50 ± 95.24) cells/μl in 16 cases of lesion progression, with statistically significant differences among the three groups (P<0.05). ConclusionsThe increase in lung lesions in patients indicates poor immune function, necessitating enhanced immune regulation. Conversely, if a decrease in T lymphocyte levels is detected during the course of the disease, attention should be given to the risk of lesion progression, and timely CT re-examinations should be conducted to monitor changes in lesions.
目的 提高对成人系统性Epstein-Barr（EB）病毒阳性T细胞淋巴组织增殖性疾病（ASEBV+T-LPD）肠道病变的认识。 方法 报道2012年3月－10月我院收治的2例以肠道病变为首发表现的ASEBV+T-LPD，并结合3例文献报道进行分析讨论。 结果 2例成人患者以腹泻为主要表现，伴有发热、淋巴结长大，初期分别误诊为结核及肠道感染，淋巴结病检提示多克隆EBER+的T淋巴细胞浸润，确诊ASEBV+T-LPD。例1经3 周期GLIDE方案（吉西他滨+门冬酰胺酶+异环磷酰胺+地塞米松+依托泊苷）化学疗法（化疗）后疾病进展，死于肺部感染。例2经干扰素联合抗病毒药物治疗，病情稳定。复习文献目前仅3例以肠道病变为首发表现的ASEBV+T-LPD被报道，早期均被误诊为炎性肠病或感染，3例均出现肠道穿孔或大出血等并发症，其中2例死亡。 结论 成人系统性EB病毒阳性T细胞淋巴组织增殖性疾病的肠道病变较为罕见，容易误诊为结核及炎性肠病。部分患者病情进展迅速，可出现肠道穿孔及消化道大出血等致死性并发症，死亡率高，预后差。确诊本病需密切结合临床和病理学检查。常规化疗及抗病毒治疗仅部分有效，不能维持长期缓解。
目的：了解左旋门冬酰胺酶（L-ASP）对儿童急性淋巴细胞白血病凝血功能变化的影响。方法：观察86例患儿在诱导缓解后治疗期间，L-ASP使用前后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、抗凝血酶Ⅲ(AT-Ⅲ)、D-二聚体变化情况。结果：与用药前比,用药结束后一天的PT、APTT、TT均显著延长(P＜0.01);FIB、AT-Ⅲ显著降低(P＜0.01),D-二聚体显著升高(P＜0.01);用药结束后1周时PT、APTT、TT、D-二聚体较用药前差异无显著性,FIB、AT-Ⅲ虽有回升,但仍低于正常(P＜0.01)。结论：L-ASP可引起ALL患儿凝血功能异常，尤其对FIB、AT-Ⅲ影响明显，应引起临床高度重视。Ｌ-Ａｓｐ主要影响蛋白质的合成而引起蛋白质成份的凝血因子减少,从而引起凝血功能障碍,且对纤维蛋白原的合成影响更为显著。
【Abstract】ObjectiveTo summarize the experience in diagnosis and treatment for chronic lymphocytic thyroiditis or complicated with other thyroid diseases． MethodsSeventyseven patients were diagnosed as chronic lymphocytic thyroiditis or complicated with other thyroid diseases by operation and histological examination at this department from November 2002 to March 2005. All their clinical records including general information, the results of careful physical examination， thyroid correlated hormone tests， color Doppler, fine needle aspiration cytological examination and some intraoperative examinations have been retrospectively analyzed in this report. ResultsThere were 53 cases of simple chronic lymphocytic thyroiditis, 10 cases complicated by papillary carcinoma， 1 case complicated by follicular carcinoma， 2 cases complicated by nonHodgkin’s lymphoma, 6 cases complicated by nodular goiter, 4 cases complicated by follicular adenoma, and 1 complicated by parathyroid adenoma. Almost all the operations were successfull and the symptoms of the diseases were alleviated. Seventytwo patients had been followed up ranging from two months to two years differently and none of them relapsed. Sixtythree of these patients have received thyrine inhibition and vicariousness treatment, 2 patients who complicated by nonHodgkin’s lymphoma had been hospitalized and 7 patients complicated by carcinoma were treated with iodine131. ConclusionThe clinical manifestations of chronic lymphocytic thyroiditis are complex, and it often complicated with other thyroid disease, which make it difficult to diagnose the diseases before operation. However, some ancillary methods such as careful physical examination， thyroid correlated hormone tests， color Doppler and fine needle aspiration cytological examination may improve the accuracy of preoperative diagnosis. Intraoperative thyroid lamellar section and frozen histological examination are also very important for intraoperative diagnosis and operative modality selection．
Severe pneumonia remains a critical global concern. The immune and cytokine imbalance mediated by lymphocytes are related to the severe transformation and tissue damage of pneumonia, and are expected to become potential therapeutic targets for severe pneumonia. This article elaborates on the protection and pathogenic mechanism of lymphocyte in severe pneumonia, and further introduces the clinical application and research status of host-directed immunotherapy in severe pneumonia from two aspects: enhancing host immunity and improving immunopathological damage. It also introduces the challenges faced by immunotherapy in the future clinical translational application, aiming to provide new thinking directions for its clinical diagnosis, treatment, and research.
ObjectiveTo explore the risk factors of nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy.MethodsThe children with acute lymphoblastic leukemia who were admitted to the Department of Pediatrics, Huai’an First Hospital Affiliated to Nanjing Medical University between December 2012 and December 2018 were divided into the infection group (including the severe infection subgroup and the non-severe infection subgroup) and the non-infection group according to whether nosocomial infection occurred during induction and remission chemotherapy. The clinical data of patients were collected. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia.ResultsA total of 96 patients were included. There were 67 cases in the infection group (26 in the severe infection subgroup and 41 in the non-severe infection subgroup) and 29 cases in the non-infection group. Univariate analysis showed that the granulocyte deficiency time and the prevalence of skin and mucosal damage in the infection group were significantly higher than those in the non-infection group, and the infection group had significantly lower laminar bed use and serum albumin level than the non-infection group did (P< 0.05). Multivariate logistic regression analysis showed that prolonged agranulocytosis [odds ratio (OR)=23.075, 95% confidence interval (CI) (3.682, 144.617), P=0.001], skin and mucosal lesions [OR=12.376, 95%CI (1.211, 126.507), P=0.034], hypoalbuminemia [OR=5.249, 95%CI (1.246, 22.113), P=0.024] were independent risk factors for nosocomial infection during induction and remission of childhood acute lymphoblastic leukemia, while laminar bed [OR=0.268, 95%CI (0.084, 0.854), P=0.026] was the protective factor.ConclusionsLong-term agranulocytosis, skin and mucosal lesions, and hypoalbuminemia are independent risk factors for nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy. Laminar flow bed is its protective factor.
Objective To investigate the relevance and changes of mucosal immunity in asthma rats’lung, nose and intestine. Methods Twenty Wistar rats were randomly divided into a normal group and an asthma group. Asthma rat model was established by sensitization and challenge with ovalbumin. CD4 + ,CD8 + , eotaxin protein and its mRNA in rats’lung tissues, rhinal and intestinal mucosa were measured by immunohistochemical methods and situ hybridization. The content of sIgA in bronchoalveolar lavage fluid ( BALF) , nasopharyngeal washings and intestinal mucus supernatant were detected by enzyme-linked immunosorbent assay. Results Compared with the normal group, the levels of CD4 + , CD8 + in rats’lung tissues, rhinal and intestinal mucosa, the expression of eotaxin protein and mRNA in rats’lung tissues, the content of sIgA in nasopharyngeal washing, and the expression of eotaxin protein in intestinal mucosa were significantly higher in the asthma group( P lt; 0. 05) . There were no significant differences of other indices between the two groups. In the normal group, the eotaxin protein expression had a negative correlationbetween lung tissue and rhinal mucosa( r = - 0. 572, P = 0. 008) , and a positive correlation between intestinal and rhinal mucosa( r=0. 638, P =0. 002) . The eotaxin mRNA expression had a positive correlation between lung tissue and rhinal mucosa( r= 0. 502, P = 0. 024) , and a positive correlation between intestinaland rhinal mucosa( r=0. 594, P =0. 006) . In the asthma group, such a correlation was not found except the eotaxin protein expression which had a negative correlation between lung tissue and intestinal mucosa( r =- 0. 448, P = 0. 048) . Conclusions Mucosal immunity in lung, nose and intestine remains a dynamic balance. The balance of mucosal immunity is destroyed in asthma.