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The clinical characteristics and risk factors for necrotizing pneumonia caused by Mycoplasma pneumoniae in children.

小儿肺炎支原体肺炎坏死性肺炎的临床特点及危险因素分析 [j].

  • 影响因子:2.79
  • DOI:10.1186/s12879-020-05110-7
  • 作者列表:"Zheng B","Zhao J","Cao L
  • 发表时间:2020-06-01
Abstract

BACKGROUND:The incidence of necrotizing pneumonia (NP) caused by Mycoplasma pneumoniae (MP) is increasing. We analyzed the clinical characteristics and the risk factors for NP caused by MP. METHODS:A retrospective observational study was conducted in 37 patients with NP caused by MP (NP group) and 74 patients diagnosed with lobar M. pneumoniae pneumonia with no necrosis (control group) who were admitted to our hospital between January 2013 and December 2017. The clinical manifestations, laboratory data, imaging findings, treatments and outcomes were analyzed. RESULTS:The proportion of females, the incidence of pleural effusion, fever duration, hospitalization days, white blood cell count, neutrophil ratio, D-dimer level and use of other types of antibiotics were higher in the NP group than in the control group (P < 0.05). The control group exhibited a greater use of low molecular weight heparin (LMWH) than the NP group (P < 0.05). According to the multivariate logistic regression analysis, a white blood cell count > 12.3 × 109/L (Odds ratio, OR = 6.412), a neutrophil ratio > 73.9% (OR = 6.081) and D-dimer level > 1367.5 ng/mL (OR = 8.501) were risk factors for pulmonary necrosis caused by MP. Furthermore, the use of LMWH (OR = 0.074) reduced the risk of pulmonary necrosis. CONCLUSIONS:NP is a rare complication of severe Mycoplasma pneumoniae pneumonia (SMPP), and although the clinical course is longer than common MP infection, the necrotic area is absorbed gradually. In patients with SMPP presenting with lobar consolidation, a white blood cell count > 12.3 × 109/L, a neutrophil ratio > 73.9% and D-dimer level > 1367.5 ng/mL are risk factors for pulmonary necrosis, and the use of LMWH reduces the risk of pulmonary necrosis.

摘要

背景: 由肺炎支原体e (MP) 引起的坏死性肺炎 (NP) 的发病率呈上升趋势。分析MP致NP的临床特点及危险因素。 方法: 回顾性观察性研究方法37例NP引起MP (NP组) 和74例患者诊断为脑叶M.肺炎 (肺炎无坏死 (对照组) 进行前来该院2013和十二月20 17.分析其临床表现、实验室检查、影像学表现、治疗及转归。 结果: NP组女性比例、胸腔积液发生率、发热持续时间、住院天数、白细胞计数、中性粒细胞比例、D-二聚体水平及其他类型抗生素的使用均高于对照组 (p <0.05)。对照组显示出比NP组更多使用低分子量肝素 (LMWH) (p <0.05)。根据多因素logistic回归分析,白细胞计数> 12.3 × 109/L (比值比,or = 6.412),中性粒细胞比率> 73.9% (or = 6.081) 和D-二聚体水平> 1367.5 (or = 8.501) 是MP致肺坏死的危险因素。此外,使用LMWH (or = 0.074) 降低了肺坏死的风险。 结论: 肺炎支原体肺炎 (NP) 是重症支原体肺炎 (SMPP) 的罕见并发症,虽然临床病程较普通MP感染长,但坏死区域逐渐吸收。SMPP表现为肺叶实变的患者,白细胞计数> 12.3 × 109/L,中性粒细胞比例> 73.9% 和D-二聚体水平> 1367.5 ng/mL是肺坏死的危险因素,使用LMWH可降低肺坏死的风险。

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影响因子:6.93
发表时间:2020-01-01
DOI:10.1002/ijc.32419
作者列表:["Milosevic V","Kopecka J","Salaroglio IC","Libener R","Napoli F","Izzo S","Orecchia S","Ananthanarayanan P","Bironzo P","Grosso F","Tabbò F","Comunanza V","Alexa-Stratulat T","Bussolino F","Righi L","Novello S","Scagliotti GV","Riganti C"]

METHODS::Malignant pleural mesothelioma (MPM) is a tumor with high chemoresistance and poor prognosis. MPM-initiating cells (ICs) are known to be drug resistant, but it is unknown if and how stemness-related pathways determine chemoresistance. Moreover, there are no predictive markers of IC-associated chemoresistance. Aim of this work is to clarify if and by which mechanisms the chemoresistant phenotype of MPM IC was due to specific stemness-related pathways. We generated MPM IC from primary MPM samples and compared the gene expression and chemo-sensitivity profile of IC and differentiated/adherent cells (AC) of the same patient. Compared to AC, IC had upregulated the drug efflux transporter ABCB5 that determined resistance to cisplatin and pemetrexed. ABCB5-knocked-out (KO) IC clones were resensitized to the drugs in vitro and in patient-derived xenografts. ABCB5 was transcriptionally activated by the Wnt/GSK3β/β-catenin/c-myc axis that also increased IL-8 and IL-1β production. IL-8 and IL-1β-KO IC clones reduced the c-myc-driven transcription of ABCB5 and reacquired chemosensitivity. ABCB5-KO clones had lower IL-8 and IL-1β secretion, and c-myc transcriptional activity, suggesting that either Wnt/GSK3β/β-catenin and IL-8/IL-1β signaling drive c-myc-mediated transcription of ABCB5. ABCB5 correlated with lower time-to-progression and overall survival in MPM patients treated with cisplatin and pemetrexed. Our work identified multiple autocrine loops linking stemness pathways and resistance to cisplatin and pemetrexed in MPM IC. ABCB5 may represent a new target to chemosensitize MPM IC and a potential biomarker to predict the response to the first-line chemotherapy in MPM patients.

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发表时间:2020-01-01
DOI:10.1016/j.jiph.2019.05.013
作者列表:["Nishimura A","Yamaguchi H","Ito Y","Tokumoto S","Toyoshima D","Kasai M","Maruyama A"]

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胸膜疾病方向

胸膜疾病包括原发于胸膜的疾病,主要指胸膜间皮瘤,也包括胸膜腔内的异常情况,如脓胸、 血胸、胸腔积液等。

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