Objective To identify the best therapy regimen for a patient with rare hypoglycemia due to insulin autoantibody (IAA). Methods We searched The Cochrane Library (Issue 3, 2008), PubMed (1966-July 2009), EMbase (1974-July 2009) and CBM (1978-July 2009) to identify relevant evidence. The quality of the retrieved studies was critically assessed. Results A total of 291 records were retrieved. No clinical guidelines, systematic reviews or clinical randomized studies were identified. Thirty treatment-related studies involving 6 interventions showed that insulin combined with Prednisone was relatively more effective and safer than conventional therapies. Conclusion The steroid treatment might be useful for the improvement of glycamic control in patients with high IAA levels and severe hypoglycemia and hyperglycemia due to insulin antibodies raised against subcutaneously-injected human insulin.
ObjectiveTo analyze the clinical characteristics and renal outcome of elderly patients with antineutrophil cytoplasmic autoantibody (ANCA) associated vasculitis (AAV) with renal involvement. MethodsWe retrospectively analyzed the clinical data of 147 patients with ANCA relate vasculitis treated between June 2006 and June 2012. Based on the age, the patients were divided into elderly group (65 years or older, n=50) and non-elderly group (younger than 65, n=97). The disease course, clinical characteristics, ANCA serological indexes, renal pathological change and prognosis of patients in the two groups were compared and studied. ResultsIn the elderly group, there were 3 cases of Wegener granulomatosis (WG), 45 of microscopic polyangiitis (MPA), and 2 of pauci-immune crescentic glomerulonephritis (PICGN). The non-elderly group had 8 cases of WG, 82 of MPA, 6 of PICGN, and 1 of allergic angitis granulomatosis. There were 5 cases of positive cANCA and 44 of positive pANCA in the elderly group. The elderly patients had significantly more pulmonary involvement than the younger patients (P=0.030). No significant difference was detected between the two groups in combined pulmonary infection (P=0.281) or combined infectious index C-reactive protein (P=0.326). Elderly patients were less likely to respond to sufficient treatment with pulse intravenous methylprednisolone therapy (P=0.035) and cyclophosphamide (P=0.043), and had worse renal outcome than younger patients (P=0.040). ConclusionElderly patients with AAV have more prevalent pulmonary involvement and have severe complication of pulmonary infection, which affects mortality and morbidity of ANCA-associated systemic vasculitis.
ObjectiveTo investigate the regulation mechanism of neutrophils extracellular traps (NETs) on inflammatory diseases and to provide guidance for the treatment of related inflammatory diseases.MethodThe literatures about the relationship between NETs and inflammatory diseases were reviewed.ResultsNETs played an important role in sepsis, anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis, acute pancreatitis, inflammatory bowel disease, and other inflammatory diseases, which were related to the development or activity of the diseases. By regulating the formation of NETs pathway, reducing the production of NETs, we could ultimately reduce the inflammation of the disease.ConclusionNETs is involved in the course of sepsis, ANCA-associated vasculitis, acute pancreatitis, inflammatory bowel disease, and other inflammatory diseases, but further investigation and clinical inflammatory verification are needed.
Serum anti-retinal autoantibodies (ARA) are a group of autoantibodies that bind to retinal auto-antigens with significant biological importance in pathological processes such as retinal degeneration, inflammatory microenvironment formation, and tissue destruction. In recent years, the expression of serum anti-retinal antibodies has been found to be upregulated in patients with various blinding retinal diseases such as age-related macular degeneration, autoimmune retinopathy, and retinitis pigmentosa, closely correlated with the progression of diseases. However, current researches on ARA are incomplete, lacking animal experiments and large randomized controlled clinical trials. As a result, the exact mechanism of ARA is not well understood. Although several studies have demonstrated that serum ARA has an important diagnostic value in hereditary, autoimmune, and degenerative retinal diseases, there still lacks recognized laboratory tests and laboratory indicators with high specificity and sensitivity. Clinical symptoms should be considered when making definitive diagnosis of the diseases. Therefore, clarifying the mechanisms of ARA in retinal dystrophies provides new ideas in early diagnosis and treatments of retinal diseases, which is clinically and scientifically important for the maintenance of visual functions.
ObjectiveBy combining biological detection and imaging evaluation, a clinical prediction model is constructed based on a large cohort to improve the accuracy of distinguishing between benign and malignant pulmonary nodules. MethodsA retrospective analysis was conducted on the clinical data of the 32 627 patients with pulmonary nodules who underwent chest CT and testing for 7 types of lung cancer-related serum autoantibodies (7-AABs) at our hospital from January 2020 to April 2024. The univariate and multivariate logistic regression models were performed to screen independent risk factors for benign and malignant pulmonary nodules, based on which a nomogram model was established. The performance of the model was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). ResultsA total of 1 017 patients with pulmonary nodules were included in the study. The training set consisted of 712 patients, including 291 males and 421 females, with a mean age of (58±12) years. The validation set included 305 patients, comprising 129 males and 176 females, with a mean age of (58±13) years. Univariate ROC curve analysis indicated that the combination of CT and 7-AABs testing achieved the highest area under the curve (AUC) value (0.794), surpassing the diagnostic efficacy of CT alone (AUC=0.667) or 7-AABs alone (AUC=0.514). Multivariate logistic regression analysis showed that radiological nodule diameter, nodule nature, and CT combined with 7-AABs detection were independent predictors, which were used to construct a nomogram prediction model. The AUC values for this model were 0.826 and 0.862 in the training and validation sets, respectively, demonstrating excellent performance in DCA. ConclusionThe combination of 7-AABs with CT significantly enhances the accuracy of distinguishing between benign and malignant pulmonary nodules. The developed predictive model provides strong support for clinical decision-making and contributes to achieving precise diagnosis and treatment of pulmonary nodules.