The clinical characteristics and risk factors for necrotizing pneumonia caused by Mycoplasma pneumoniae in children.
- 作者列表："Zheng B","Zhao J","Cao L
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.
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。
METHODS:BACKGROUND:The most common sites of malignant mesothelioma are the pleura and peritoneum, but little is known about the incidence, prognosis, or treatment of patients with disease in both cavities. Previous series suggest that multimodality treatment improves overall survival for pleural or peritoneal disease, but studies typically exclude patients with disease in both cavities. Despite limitations, this investigation is the only study to broadly examine outcomes for patients with malignant mesothelioma in both the pleural and peritoneal cavities. METHODS:This study retrospectively examined 50 patients with both pleural and peritoneal mesothelioma treated with the intent to prolong survival. The primary end point was overall survival from the initial operative intervention. RESULTS:The median overall survival was 33.9 months from the initial intervention. Female gender and intraperitoneal dwell chemotherapy were independent predictors of overall survival. Within 1 year after the initial diagnosis, second-cavity disease was diagnosed in 52% of the patients. The median time to the second-cavity diagnosis for those with a diagnosis 1 year after the initial diagnosis was 30 months. CONCLUSIONS:Well-selected patients with both pleural and peritoneal mesothelioma have a survival benefit over palliative treatment that is comparable with that seen in single-cavity disease. The presence of disease in both cavities is not a contraindication to multimodality treatment aimed at prolonging survival, whether the disease is diagnosed synchronously or metachronously. Patients with an initial diagnosis of single cavity disease are at the highest risk for identification of second-cavity disease within the first year after diagnosis.
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.
METHODS::Empyema necessitatis (EN) is a rare complication of empyema in which the pleural infection spreads outside the pleural space. Lower airway infections are common among children with cerebral palsy (CP). Although harmless to healthy individuals, Pseudomonas aeruginosa can cause invasive infections, including CP, in immunocompromised hosts. Mycobacterium tuberculosis and Actinomyces spp. have been reported as common causative organisms of EN. However, EN caused by P. aeruginosa has never been reported. We report the case of an 8-year-old girl with CP without tracheotomy who was admitted to our hospital with complaints of fever and increased epileptic seizures. First, she was diagnosed with pneumonia and treated with antibiotics. However, seven days after admission, a palpable mobile mass overlying the lower part of the shoulder blade was noticed. Enhanced magnetic resonance imaging revealed broad high signal area on T2-weighted and diffusion-weighted images, indicating empyema of the left lower lung that had penetrated the pleural wall and spread to the subcutaneous area of the left back. Thus, she was diagnosed with EN. Twelve days after admission, P. aeruginosa was detected from the pus culture. Patients with CP who have chronic lung diseases, such as pneumonia, atelectasis, or empyema, may need careful follow up.