Waldenström macroglobulinemia (WM) is a rare indolent lymphoplasmacytic lymphoma. Bruton’s tyrosine kinase (BTK) plays a key role in the signaling pathway of WM, which has changed the way of treatment of WM. As a first-generation BTK inhibitor, ibrutinib is an early-stage treatment and a salvage treatment that can control toxicity characteristics. However, in order to overcome the resistance of the first-generation BTK inhibitors, reduce the adverse reactions caused by off-target effects, and improve the efficacy, the research and development of new BTK inhibitors has become a hot topic. This article discusses the clinical studies of the first generation and new BTK inhibitors for WM, aiming to provide a certain basis for the more rational application of BTK inhibitors in WM.
Objective To retrieve, evaluate, and summarize evidence on the prevention and management of intracranial infections related to lumbar drainage (LD), in order to provide scientific references for clinical practice and decision-making. Methods The literature on the prevention and management of LD-related intracranial infections in LD-related websites and databases was systematically searched, with a search period from the establishment of databases to June 30, 2024. The included literature was evaluated for quality and integrated into evidence. Results A total of 9 articles were included, including 3 guidelines, 1 evidence summary, 1 expert consensus, 1 systematic review, and 3 original studies. A total of 30 pieces of evidence were formed, covering six aspects: risk management, catheter placement, catheter maintenance, extubation, diagnosis and treatment of intracranial infections, education and training. ConclusionsThe prevention and management of LD-related intracranial infections involve multiple pieces of evidence, and medical staff should selectively apply the best evidence based on patient and clinical conditions to reduce the incidence of intracranial infections and improve medical quality.
Regulatory B cells (Bregs) are a subset of B cells with immunomodulatory effects. The study of Bregs began with a variety of animal models of immune diseases. Studies in patients with autoimmune diseases have further clarified that Bregs are a group of immune cells that secrete inhibitory cytokines such as interleukin-10. Abnormal functions and numbers of Bregs have been found in a variety of autoimmune diseases. The study of the negative immune regulatory network involving Bregs is expected to provide new therapeutic ideas for diseases such as immune diseases, cancer, infection and inflammation. Starting from the discovery and immune regulation mechanism of Bregs, this paper focuses on its regulatory mechanism and clinical research value in the occurrence and development of autoimmune diseases, tumors, infectious diseases and inflammation.
ObjectiveTo evaluate the efficacy and safety of bronchoscope in the treatment of transbronchial broncholiths.MethodsThe clinical data, treatment methods, clinical efficacy and complications of 18 patients who were diagnosed with transbronchial broncholiths were etrospectively reviewed in the Respiratory Department of the Second Hospital of Lanzhou University during January 2010 to December 2017.ResultsEighteen patients were diagnosed by bronchoscopy with a total of 22 pieces of stone for transbronchial broncholiths. An elective surgical procedure was performed in 2 cases. Six cases were treated with removing broncholiths once by foreign body forceps under bronchoscope. Repeated treatments were performed in 10 patients. Two cases underwent massive hemorrhage in the process of one-time broncholiths removal by foreign body forceps under bronchoscope, and one case suffered from bronchial fistula after the broncholiths removal, all of the above 3 patients underwent surgical treatment. All patients were followed up for 5 months without any long-term complications.ConclusionsRemoval of broncholithiasis by bronchoscopic forceps can effectively treat transbronchial broncholiths with low complication and high safety. If the broncholiths cause severe distal lung tissue injury, massive hemoptysis, bronchial fistula, or the diagnosis is unclear, surgical treatment is required. When the transbronchial broncholith is difficult to remove completely at once, batch could be chosen. First, to remove one portion which causes the obstruction of airway; and then, to remove the left part of the transbronchial broncholith by stages.
ObjectiveTo investigate the clinical effect of No. 8 blood collection needles in connecting broken balloon tubes. MethodsThirty-six patients who underwent mechanical ventilation in the Intensive Care Unit between January 2010 and December 2013 were included as the study subjects. We divided them into two groups. Patients who had accidental rupture of balloon tube during intubation were regarded as the trial group, while those with normal ventilation were regarded as the control group, with each group having 18 patients. The trial group used No. 8 disposable blood collection needles to connect the balloon tubes. Pressure gauge produced in Germany was used to measure the balloon pressure continuously for four hours. Balloon pressure level, balloon leakage and tube dislocation within 24 hours were observed. ResultsThe balloon pressure at different time periods was not significantly different between the two groups (P > 0.05). The leakage rate and complication rate were also not significantly different between the two groups (P > 0.05). ConclusionsUsing No. 8 blood collection needles for connecting broken balloon tubes is effective, easy, and convenient, and the balloon can be maintained at a constant pressure. It solved many previous clinical problems such as high cost, high complication rate, high death rate and medical disputes.
Objective To analyze the influencing factors of hemorrhagic transformation (HT) after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke (AIS). Methods AIS patients hospitalized in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University between June 2017 and June 2020 and receiving rt-PA intravenous thrombolysis were selected. Patients were divided into two groups according to whether they had HT, HT group and non-HT group. General data such as patient’s age, sex, past history, score of National Institute of Health Stroke Scale (NIHSS) before thrombolysis, and related biochemical examination indicators were collected, to analyze the difference between the patients with HT or not, and analyze the related factors affecting the HT of AIS patients after intravenous thrombolysis. Results A total of patients 323 were included. Among them, 46 cases (14.2%) had HT, and 277 cases (85.8%) had no-HT. Except for serum free triiodothyronine (FT3), atrial fibrillation, hypertension, cerebral infarction area, NIHSS score before thrombolysis, uric acid, blood glucose before thrombolysis, white blood cell count, albumin level, alanine aminotransferase, aspartate aminotransferase / alanine aminotransferase and C-reactive protein (P<0.05), there was no significant difference in other indexes between the two groups (P>0.05). Logistic regression analysis showed that NIHSS score≥13 before thrombolysis, aspartate aminotransferase / alanine aminotransferase, blood glucose before thrombolysis≥12.74 mmol/L, low FT3 level, massive cerebral infarction, and atrial fibrillation were independent risk factors for HT after thrombolysis in AIS. Conclusions FT3 and aspartate aminotransferase / alanine aminotransferase levels may be good biomarkers for predicting HT after intravenous thrombolysis. For patients with reduced albumin and uric acid levels, supplementation of exogenous uric acid and albumin may help reduce the risk of HT after AIS thrombolysis.