hematological diseases

血液病
  • 文章类型: Journal Article
    细胞粘附是一个在细胞增殖中起着基础性作用的动态过程,维护,分化,和移民。基底细胞粘附分子(BCAM),也被称为路德(Lu),属于细胞粘附分子的免疫球蛋白超家族。Lu/BCAM,在红细胞中广泛表达,内皮细胞,各种组织的平滑肌细胞和上皮细胞,在许多细胞过程中发挥关键作用,包括细胞粘附,细胞运动和细胞迁移。此外,Lu/BCAM,在许多疾病中失调,比如血液疾病和各种类型的癌症,可以作为生物标志物和治疗这些疾病的靶标。本文就Lu/BCAM在细胞黏附中的意义及其作为血液系统疾病和肿瘤治疗新靶点的潜力作一综述。
    Cell adhesion is a dynamic process that plays a fundamental role in cell proliferation, maintenance, differentiation, and migration. Basal cell adhesion molecule (BCAM), also known as Lutheran (Lu), belongs to the immunoglobulin superfamily of cell adhesion molecules. Lu/BCAM, which is widely expressed in red blood cells, endothelial cells, smooth muscle cells and epithelial cells across various tissues, playing a crucial role in many cellular processes, including cell adhesion, cell motility and cell migration. Moreover, Lu/BCAM, dysregulated in many diseases, such as blood diseases and various types of cancer, may act as a biomarker and target for the treatment of these diseases. This review explores the significance of Lu/BCAM in cell adhesion and its potential as a novel target for treating hematological diseases and tumors.
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  • 文章类型: Journal Article
    患有血液病的患者被认为具有耐碳青霉烯的革兰氏阴性细菌(CR-GNB)的肠道定植的风险很高。然而,在中国,有关该人群中肠道定植的CR-GNB分离株的危险因素和分子特征的流行病学数据不足。进行了一项多中心病例对照研究,涉及来自中国92家医院的4,641名成人血液病患者。收集的直肠拭子培养后,进行了质谱和抗菌药物敏感性试验以鉴定GNB物种和CR表型。通过回顾性临床资料评估危险因素。全基因组测序用于分析CR-GNB分离株的分子特征。该试验在ClinicalTrials.gov注册为NCT05002582。我们的结果表明,在4,641名成年患者中,10.8%的人通过CR-GNB进行肠道定植。其中,8.1%被耐碳青霉烯类肠杆菌(CRE)定植,2.6%被耐碳青霉烯类铜绿假单胞菌(CRPA)定植,耐碳青霉烯鲍曼不动杆菌(CRAB)定植了0.3%。CR-GNB定植的危险因素包括男性,急性白血病,造血干细胞移植,β-内酰胺抗生素的使用,1周内出现非肛周感染。与CRPA定植患者相比,使用碳青霉烯类抗生素的患者更有可能被CRE定植.NDM是定植CRE中主要的碳青霉烯酶。这项研究揭示了在中国成人血液病患者中CR-GNB肠道定植率较高,CRE是主要的。值得注意的是,相当比例的CRE表现出金属β-内酰胺酶的产生,表明了一个令人担忧的趋势。这些发现强调了积极筛查血液疾病患者CR-GNB定植的重要性。耐IMPORTANCECarbapenem的革兰氏阴性菌(CR-GNB)已成为对公共卫生的重大威胁。血液病患者由于其免疫抑制状态而处于CR-GNB感染的高风险中。CR-GNB定植是后续感染的独立危险因素。了解CR-GNB与血液病患者肠道定植相关的危险因素和分子特征,对经验性治疗至关重要。特别是发热性中性粒细胞减少症患者。然而,流行病学数据仍然不足,我们的研究旨在确定CR-GNB的肠道定植率,确定定殖风险因素,并分析CR-GNB分离株的分子特征。
    Patients with hematological diseases are considered to be at high risk for intestinal colonization by carbapenem-resistant Gram-negative bacteria (CR-GNB). However, the epidemiological data regarding risk factors and molecular characteristics of intestinal colonized CR-GNB isolates in this population are insufficient in China. A multicenter case‒control study involving 4,641 adult patients with hematological diseases from 92 hospitals across China was conducted. Following culture of collected rectal swabs, mass spectrometry and antimicrobial susceptibility tests were performed to identify GNB species and CR phenotype. Risk factors were assessed through retrospective clinical information. Whole-genome sequencing was used to analyze the molecular characteristics of CR-GNB isolates. This trial is registered with ClinicalTrials.gov as NCT05002582. Our results demonstrated that among 4,641 adult patients, 10.8% had intestinal colonization by CR-GNB. Of these, 8.1% were colonized by carbapenem-resistant Enterobacterales (CRE), 2.6% were colonized by carbapenem-resistant Pseudomonas aeruginosa (CRPA), and 0.3% were colonized by carbapenem-resistant Acinetobacter baumannii (CRAB). The risk factors for CR-GNB colonization include male gender, acute leukemia, hematopoietic stem cell transplantation, β-lactam antibiotic usage, and the presence of non-perianal infections within 1 week. Compared with CRPA-colonized patients, patients using carbapenems were more likely to be colonized with CRE. NDM was the predominant carbapenemase in colonized CRE. This study revealed a high CR-GNB intestinal colonization rate among adult patients with hematological diseases in China, with CRE being the predominant one. Notably, a significant proportion of CRE exhibited metallo-β-lactamase production, indicating a concerning trend. These findings emphasize the importance of active screening for CR-GNB colonization in patients with hematological diseases.IMPORTANCECarbapenem-resistant Gram-negative bacteria (CR-GNB) has emerged as a significant threat to public health. Patients with hematological diseases are at high risk of CR-GNB infections due to their immunosuppressed state. CR-GNB colonization is an independent risk factor for subsequent infection. Understanding the risk factors and molecular characteristics of CR-GNB associated with intestinal colonization in patients with hematological diseases is crucial for empirical treatment, particularly in patients with febrile neutropenia. However, the epidemiology data are still insufficient, and our study aims to determine the intestinal colonization rate of CR-GNB, identify colonization risk factors, and analyze the molecular characteristics of colonized CR-GNB isolates.
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  • 文章类型: Journal Article
    本文介绍了2例多发性骨髓瘤,自体干细胞移植过程中的COVID-19感染,治疗过程,和两个病人的不同结果,为COVID-19规范化阶段如何安全进行ASCT提供参考。
    This paper introduces two cases of multiple myeloma, COVID-19 infection during autologous stem cell transplantation, the treatment process, and different results of the two patients, which provides a reference for how to carry out ASCT safely during the COVID-19 normalization stage.
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  • 文章类型: Journal Article
    目的:探讨卵巢组织冷冻保存(OTC)在女性血液病患者中保存生育功能的效果和安全性。
    方法:我们设计了一项回顾性研究。对2017年4月至2023年1月北京大学人民医院收治的OTC血液病患者的临床资料进行分析总结。
    结果:本研究共纳入24例患者,其中恶性血液病患者19例,非恶性血液病患者5例。前者包括14例急性白血病患者,1例慢性白血病患者,和4名骨髓增生异常综合征患者,后5例患者为再生障碍性贫血(AA)。16例患者在OTC前接受化疗。24例患者的平均年龄为22.80±6.81岁。平均抗苗勒管激素(AMH)为1.97±2.12ng/mL,OTC前检查卵泡刺激素(FSH)平均为7.01±4.24IU/L。4例FSH大于10.0IU/L。OTC前实验室检测显示,白细胞(WBC)计数平均值为(3.33±1.35)×109/L,平均血红蛋白为91.42±22.84g/L,平均血小板(147.38±114.46)×109/L注射重组人粒细胞集落刺激因子(rhG-CSF)后,输血,在OTC前治疗中补充铁,白细胞计数平均值为(4.91±3.07)×109/L,平均血红蛋白为98.67±15.43g/L,平均血小板(156.38±103.22)×109/L在24名患者中,22例行腹腔镜双侧部分卵巢切除术和卵巢成形术,2例接受腹腔镜单侧卵巢切除术。OTC的平均持续时间为59.54±17.58分钟,平均失血量为32.1±41.6mL。最大失血量为200mL。与OTC前相比,OTC后的WBC计数和血红蛋白浓度没有显着差异。仅OTC手术后的血小板计数与手术前存在显着差异([134.54±80.84vs.156.38±103.22]×109/L,p<0.05)。24例患者无一发生OTC术后严重并发症。2例患者有轻度感染症状,但两者都恢复得很好。23例患者在OTC后行造血干细胞移植(HSCT)。从OTC到HSCT预处理的中位数和四分位数范围为33(57)天,从OTC到HSCT的中位数和四分位数范围为41(57)天。其中7人在20天内开始HSCT预处理,并在OTC后30天内开始HSCT。所有患者均获得随访。在手术后接受HSCT的23例患者中,22例表现为闭经,1例表现为月经很少。7例患者在HSCT后接受了激素替代疗法(HRT)。一名AA患者在HSCT后3年接受了卵巢组织移植(OTT),并在OTT后6个月恢复了正常月经。
    结论:卵巢组织冷冻保存在血液病患者的生育保护方面具有广阔的前景。然而,恶性血液病患者通常在OTC前接受过性腺毒性治疗,可能伴有骨髓抑制,而非恶性血液病患者常伴有严重的血细胞减少。所以围手术期应重视患者的全血细胞计数。血液病患者OTC手术前后WBC计数和血红蛋白浓度无显著差异,血小板计数在正常范围内略有下降。感染是OTC后最常见的并发症,早在OTC后第10天就可以接受HSCT预处理。OTC对血液病患者无不良影响,不延迟HSCT治疗。对于年轻的血液病患者,OTC是一种有效的生育力保存方法。
    OBJECTIVE: To investigate the effect and safety of ovarian tissue cryopreservation (OTC) for fertility preservation in female patients with hematological diseases.
    METHODS: We designed a retrospective study. The clinical data of patients with hematological diseases undergoing OTC admitted to Peking University People\'s Hospital from April 2017 to January 2023 were analyzed and summarized.
    RESULTS: A total of 24 patients were included in the study, including 19 patients with malignant hematological diseases and 5 patients with non-malignant hematological diseases. The former included 14 patients with acute leukemia, 1 patient with chronic leukemia, and 4 patients with myelodysplastic syndrome, while the latter 5 patients were aplastic anemia (AA). 16 patients had received chemotherapy before OTC. The average age of 24 patients was 22.80 ± 6.81 years. The average anti-Mullerian hormone (AMH) was 1.97 ± 2.12 ng/mL, and the average follicle-stimulating hormone (FSH) was 7.01 ± 4.24 IU/L in examination before OTC. FSH was greater than 10.0 IU/L in 4 cases. The pre-OTC laboratory tests showed that the average white blood cell (WBC) count was (3.33 ± 1.35) × 109/L, the average hemoglobin was 91.42 ± 22.84 g/L, and the average platelet was (147.38 ± 114.46) × 109/L. After injection of recombinant human granulocyte colony-stimulating factor (rhG-CSF), blood transfusion, and iron supplementation in pre-OTC treatment, the average WBC count was (4.91 ± 3.07) × 109/L, the average hemoglobin was 98.67 ± 15.43 g/L, and the average platelet was (156.38 ± 103.22) × 109/L. Of the 24 patients, 22 underwent laparoscopic bilateral partial oophorectomy and oophoroplasty, and 2 underwent laparoscopic unilateral oophorectomy. The average duration of OTC was 59.54 ± 17.58 min, and the average blood loss was 32.1 ± 41.6 mL. The maximum blood loss was 200 mL. There was no significant difference in WBC count and hemoglobin concentration after OTC compared to pre-OTC period. Only the platelet count after OTC surgery was significantly different from that before surgery ([134.54 ± 80.84 vs. 156.38 ± 103.22] × 109/L, p < 0.05). None of the 24 patients had serious complications after OTC. 2 patients had mild infection symptoms, but both recovered well. 23 patients underwent hematopoietic stem cell transplantation (HSCT) after OTC. The median and interquartile range from OTC to the pretreatment of HSCT was 33 (57) days, and the median and interquartile range from OTC to HSCT was 41 (57) days. Seven of them began pretreatment of HSCT within 20 days and began HSCT within 30 days after OTC. All patients were followed up. Of the 23 patients who underwent HSCT after surgery, 22 presented with amenorrhea and 1 with scanty menstrual episodes. Seven patients underwent hormone replacement therapy (HRT) after HSCT. A patient with AA underwent ovarian tissue transplantation (OTT) 3 years after HSCT and resumed regular menstruation 6 months after OTT.
    CONCLUSIONS: Ovarian tissue cryopreservation has a promising future in fertility protection in patients with hematological diseases. However, patients with hematological malignancies often have received gonadotoxic therapy before OTC, which may be accompanied by myelosuppression while patients with non-malignant hematological diseases often present with severe hemocytopenia. So perioperative complete blood count of patients should be paid attention to. There was no significant difference in the WBC count and hemoglobin concentration in patients with hematological diseases before and after OTC surgery, and the platelet count decreased slightly within the normal range. Infection is the most common post-OTC complication, and HSCT pretreatment can be accepted as early as the 10th day after OTC. OTC has no adverse effects on patients with hematological diseases and does not delay HSCT treatment. For young patients with hematological diseases, OTC is an effective method of fertility preservation.
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  • 文章类型: Journal Article
    近年来,血液肿瘤治疗的进展导致了更有效和毒性更低的治疗方案,导致患者预期寿命延长。然而,这些治疗的成功也带来了心血管不良事件的患病率增加,成为不断增长的癌症幸存者的一个重要问题。抗肿瘤疗法,靶向肿瘤和器官血管,有助于血管毒性,受遗传因素和预先存在的血管疾病的影响。化疗药物和靶向治疗可通过多种机制影响内皮细胞和心肌细胞,从而诱导心血管毒性,包括缺氧,脉管系统异常,和对心肌细胞的直接影响。心血管不良事件涵盖范围广泛,从心功能不全到心律失常风险升高。虽然早期心脏事件在临床试验中有很好的描述,由于患者的生存期延长,延迟毒性越来越重要。本文综述了抗肿瘤药物在血液病中的心脏和血管毒性,提供对癌症治疗相关心脏毒性的分子病理生理学的见解。了解这些药物如何与心脏和血管相互作用对于预测,检测,和管理化疗相关的心脏问题。
    In recent years, advancements in the treatment of hematologic neoplasms have led to more effective and less toxic therapeutic schemes, resulting in prolonged patient life expectancy. However, the success of these treatments has also brought about an increased prevalence of cardiovascular adverse events, becoming a significant concern for the growing population of cancer survivors. Antineoplastic therapies, targeting both tumor and organ vessels, contribute to vascular toxicity, influenced by genetic factors and pre-existing vascular diseases. Chemotherapeutic agents and targeted treatments can induce cardiovascular toxicity by affecting endothelial cells and cardiomyocytes through various mechanisms, including hypoxia, vasculature abnormalities, and direct effects on cardiomyocytes. Cardiovascular adverse events encompass a wide range, from cardiac dysfunction to an elevated risk of arrhythmias. While early cardiac events are well-described in clinical trials, delayed toxicities are gaining relevance due to prolonged patient survival. The review focuses on the cardiac and vascular toxicity of antineoplastic drugs in hematological disorders, providing insights into the molecular physiopathology of cancer therapy-associated cardiotoxicity. Understanding how these drugs interact with the heart and blood vessels is essential for predicting, detecting, and managing chemotherapy-related heart issues.
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  • 文章类型: Journal Article
    免疫功能低下的患者现在代表了2019年严重冠状病毒疾病风险最高的人群。据报道,这些患者持续存在严重急性呼吸道综合症冠状病毒2(SARS-CoV-2)病毒脱落,范围从几周到9个月不等。我们进行了一项双中心回顾性病例对照研究,以确定与免疫功能低下患者持续病毒脱落相关的风险和预后因素。
    在2020年3月1日至2022年4月24日期间,在巴黎的两家大学医院,回顾性地纳入了持续8周的SARS-CoV-2病毒脱落的有症状的免疫受损成人,法国,并与对照组相匹配,对照组包括没有持续病毒脱落的有症状的免疫功能低下患者。
    将29名持续病毒脱落的免疫功能低下患者与40名对照进行了比较。在多变量分析中,发热和淋巴细胞减少症(<0.5G/L)与持续病毒脱落的风险增加相关(比值比[OR]:3.3;95%置信区间[CI],1.01-11.09)P=0.048和OR:4.3;95%CI,1.2-14.7;P=0.019)。未接种疫苗的患者持续病毒脱落的风险增加了6倍(OR,6.6;95%CI,1.7-25.1;P=.006)。持续病毒脱落的患者有住院风险(OR:4.8;95CI,1.5-15.6;P=.008),侵袭性曲霉病(OR:10.17;95CI,1.15-89.8;P=0.037)和死亡(对数秩检验<0.01)。
    疫苗覆盖率对免疫功能低下患者的SARS-CoV-2持续性病毒脱落具有保护作用。这一新的一组患有SARS-CoV-2持续性病毒脱落的免疫受损患者有发展为侵袭性曲霉病和死亡的风险,因此,只要病毒脱落持续,就应系统地筛查这种真菌感染。
    UNASSIGNED: Immunocompromised patients now represent the population most at risk for severe coronavirus disease 2019. Persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral shedding was reported in these patients ranging from several weeks up to 9 months. We conducted a bicentric retrospective case-control study to identify risk and prognostic factors associated with persistent viral shedding in immunocompromised patients.
    UNASSIGNED: Symptomatic immunocompromised adults with persistent SARS-CoV-2 viral shedding >8 weeks were retrospectively included between 1 March 2020 and 24 April 2022 at 2 university hospitals in Paris, France, and matched with a control group consisting of symptomatic immunocompromised patients without persistent viral shedding.
    UNASSIGNED: Twenty-nine immunocompromised patients with persistent viral shedding were compared with 40 controls. In multivariate analysis, fever and lymphocytopenia (<0.5 G/L) were associated with an increased risk of persistent viral shedding (odds ratio [OR]: 3.3; 95% confidence interval [CI], 1.01-11.09) P = .048 and OR: 4.3; 95% CI, 1.2-14.7; P = .019, respectively). Unvaccinated patients had a 6-fold increased risk of persistent viral shedding (OR, 6.6; 95% CI, 1.7-25.1; P = .006). Patients with persistent viral shedding were at risk of hospitalization (OR: 4.8; 95 CI, 1.5-15.6; P = .008), invasive aspergillosis (OR: 10.17; 95 CI, 1.15-89.8; P = .037) and death (log-rank test <0.01).
    UNASSIGNED: Vaccine coverage was protective against SARS-CoV-2 persistent viral shedding in immunocompromised patients. This new group of immunocompromised patients with SARS-CoV-2 persistent viral shedding is at risk of developing invasive aspergillosis and death and should therefore be systematically screened for this fungal infection for as long as the viral shedding persists.
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  • 文章类型: Journal Article
    背景:头孢他啶-阿维巴坦(CAZ-AVI)治疗血液学患者碳青霉烯耐药肠杆菌(CRE)和铜绿假单胞菌(CRPA)引起的菌血症的经验有限。
    方法:我们执行了单中心,回顾性,观察性研究包括2018年至2022年期间因CRE或CRPA菌血症接受CAZ-AVI治疗的患者.主要结果是30天存活。我们进行了多变量分析以确定生存率的预测因子。
    结果:纳入56例患者,分离出57株(41株CRE和16株CRPA)。35株产生碳青霉烯酶,包括25个金属-β-内酰胺酶(MBL)和10个丝氨酸-β-内酰胺酶。48例患者(85.7%)接受联合治疗。所有MBL-CRE菌血症患者(n=24)均接受氨曲南(AZT)联合治疗。CRE对CAZ-AVI的敏感性仅为26.8%(11/41),CRPA为80.0%(8/10)。CRE组为85.0%(34/40),CRPA组为81.3%(13/16)。在MBL-CRE菌血症患者中,由于与AZT联合治疗,30天生存率高达91.7%(22/24).头孢他啶在体外不影响氨曲南-阿维巴坦对MBL-CRE的活性。多变量Cox分析显示中性粒细胞减少>14天(P=0.002,HR:34.483,95CI:3.846-333.333)和较高的Pitt菌血症评分(P=0.005,HR:2.074,95CI:1.253-3.436)是30天生存的危险因素。
    结论:CAZ-AVI在治疗CRPA和丝氨酸-β-内酰胺酶CRE引起的菌血症方面非常有效。阿维巴坦与AZT的组合在治疗由AZT抗性MBL生产者引起的菌血症方面非常有效。
    BACKGROUND: Limited experience exists with ceftazidime-avibactam (CAZ-AVI) in treating bacteremia caused by carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) in hematological patients.
    METHODS: We performed a single-center, retrospective, observational study including patients who received CAZ-AVI for bacteremia due to CRE or CRPA between 2018 and 2022. The primary outcome was 30-day survival. We conducted a multivariable analysis to identify predictors of survival.
    RESULTS: 56 patients were included and 57 (41 CRE and 16 CRPA) strains were isolated. 35 strains produced carbapenemase, including 25 metallo-beta-lactamase (MBL) and 10 serine-beta-lactamase. 48 patients (85.7 %) received combination therapy. All patients with MBL-CRE bacteremia (n = 24) received combination therapy with aztreonam (AZT). The susceptibility rates to CAZ-AVI were only 26.8 % (11/41) in CRE and 80.0 % (8/10) in CRPA. The 30-day survival rates were 85.0 % (34/40) in the CRE group and 81.3 % (13/16) in the CRPA group. In patients with MBL-CRE bacteremia, the 30-day survival was as high as 91.7 % (22/24) due to combination with AZT. Ceftazidime did not influence the activity of aztreonam-avibactam against MBL-CRE in-vitro. Multivariable cox analysis revealed neutropenia >14 days (P = 0.002, HR: 34.483, 95%CI: 3.846-333.333) and a higher Pitt bacteremia score (P = 0.005, HR: 2.074, 95%CI: 1.253-3.436) were risk factors for 30-day survival.
    CONCLUSIONS: CAZ-AVI is highly effective in treating bacteremia due to CRPA and serine-beta-lactamase CRE. The combination of avibactam with AZT is highly effective in treating bacteremia due to AZT-resistant MBL producers.
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  • 文章类型: Journal Article
    背景:耐碳青霉烯的生物体(CRO)已经成为一个重要的世界性问题。然而,用于治疗CRO感染的有效抗生素的可用性仍然有限.多粘菌素,包括硫酸粘菌素,代表针对CRO感染的最后一线治疗选择。本研究旨在回顾性评估硫酸粘菌素在治疗血液病患者CRO感染中的临床有效性和安全性。
    方法:2022年4月至2023年1月,在苏州宏慈血液病医院对118例诊断为CRO感染的血液病患者进行硫酸粘菌素治疗。评估包括临床疗效,细菌清除率,不良反应,和30天全因死亡率。
    结果:研究发现硫酸粘菌素治疗CRO感染的总有效率为74.6%,细菌清除率为72.6%。在整个治疗过程中,7.6%的病例出现肾毒性,2.5%的病例有神经毒性,30天全因死亡率为22.9%。多因素分析显示,疗程和联合用药是影响硫酸粘菌素临床疗效的独立因素。
    结论:我们的研究表明,硫酸粘菌素的治疗可以达到较高的临床疗效和微生物反应,肾毒性风险低。这项研究提供了硫酸粘菌素治疗这些患者的积极临床疗效和安全性的证据。仍需要高质量的随机对照试验来进一步证实硫酸粘菌素的有益作用。
    BACKGROUND: Carbapenem-resistant organisms (CRO) have emerged as a significant worldwide issue. However, the availability of efficacious antibiotics for treating CRO infections remains limited. Polymyxins, including colistin sulfate, represent the last-line therapeutic option against CRO infections. This study aims to retrospectively evaluate the clinical effectiveness and safety of colistin sulfate in managing CRO infections among patients with hematological diseases.
    METHODS: Between April 2022 and January 2023, a total of 118 hematological patients diagnosed with CRO infection were treated with colistin sulfate at Suzhou Hongci Hospital of Hematology. The assessment encompassed the clinical efficacy, bacterial clearance rate, adverse reactions, and 30-day all-cause mortality.
    RESULTS: The study found that the total effective rate of colistin sulfate in the treatment of CRO infection was 74.6%, with a bacterial clearance rate of 72.6%. Throughout the treatment, nephrotoxicity occurred in 7.6% of cases, neurotoxicity in 2.5% of cases, and the 30-day all-cause mortality rate was 22.9%. Multivariate logistic analysis revealed that the treatment course and combination medication with other antimicrobials were independent factors affecting the clinical efficacy of colistin sulfate.
    CONCLUSIONS: Our study demonstrates that the treatment of colistin sulfate can achieve high clinical efficacy and microbial responses, with a low risk of nephrotoxicity. This study provides evidence of the positive clinical efficacy and safety of colistin sulfate treatment in these patients. High-quality randomized controlled trials are still needed to further confirm the beneficial role of colistin sulfate.
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  • 文章类型: English Abstract
    OBJECTIVE: To assess the characteristics of the course of coronavirus infection COVID-19 and to determine the risk factors for adverse events in patients of the regional hematological center.
    METHODS: As part of an observational prospective cohort study, data from 144 medical records of patients in Primorsky Krai with hematological diseases and COVID-19 were analyzed. The data of the developed standardized questionnaire of the CHRONOS19 study were used. The primary endpoint (adverse outcome) was a composite point that included mortality from any cause during the observation period, development of acute respiratory distress syndrome, hospitalization in the intensive care unit, and the need for mechanical ventilation.
    RESULTS: A study of the features of the course of COVID-19 in hematological patients showed an increase in the number of adverse events in patients with neoplastic blood diseases, especially in chronic lymphoproliferative diseases and acute myeloid leukemia. Significant predictors of an unfavorable course of COVID-19 include a refractory/recurrent variant of the course of a blood tumor, glucocorticoid therapy as part of the protocol for the treatment of the underlying disease, stage 3-4 lung damage according to computerised tomography scans at the onset of COVID-19, and the presence of diabetes mellitus.
    CONCLUSIONS: Predictors of an unfavorable course of COVID-19 in hematological patients have been identified. Hematological patients in the context of the COVID-19 pandemic require a coordinated interdisciplinary approach involving hematologists and therapists, careful monitoring of clinical and laboratory parameters to reduce the risk of adverse events.
    Цель. Оценить особенности течения коронавирусной инфекции COVID-19 и определить факторы риска неблагоприятных событий у пациентов краевого гематологического центра. Материалы и методы. В рамках наблюдательного проспективного когортного исследования проанализированы данные 144 медицинских карт пациентов Приморского края с гематологическими заболеваниями и COVID-19. Использованы данные разработанной стандартизированной анкеты исследования CHRONOS19. Первичной конечной точкой (неблагоприятным исходом) выбрана комбинированная точка, которая включала смертность от любых причин за период наблюдения, развитие острого респираторного дистресс-синдрома, госпитализацию в отделение реанимации и интенсивной терапии и потребность в искусственной вентиляции легких. Результаты. Проведенное исследование особенностей течения COVID-19 у гематологических пациентов показало увеличение числа неблагоприятных событий у пациентов с опухолевыми заболевания крови, особенно при хронических лимфопролиферативных заболеваниях и остром миелоидном лейкозе. К значимым предикторам неблагоприятного течения COVID-19 отнесены рефрактерный/рецидивирующий вариант течения опухолевого заболевания крови, терапия глюкокортикоидами в рамках протокола лечения основного заболевания, 3–4-я стадия поражения легких по данным компьютерной томографии в дебюте COVID-19 и наличие сахарного диабета. Заключение. Определены предикторы неблагоприятного течения COVID-19 у гематологических пациентов. Пациенты гематологичес- кого профиля в условиях пандемии COVID-19 требуют согласованного междисциплинарного подхода с участием гематологов и терапевтов, тщательного мониторинга клинико-лабораторных показателей для снижения риска возникновения неблагоприятных событий.
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  • 文章类型: Journal Article
    血液病,由于其复杂的性质和多样的表现,在医疗保健方面构成了重大的诊断挑战。对早期和准确诊断的迫切需要推动了对新型诊断技术的探索。红外(IR)光谱,以其非侵入性而闻名,快速,和成本效益的特点,已成为血液学诊断中很有前途的辅助手段。这篇综述探讨了红外光谱的转化作用,并重点介绍了其在检测和诊断各种血液相关疾病中的应用。我们讨论了开创性的研究成果和现实世界的应用,同时提供了该技术的潜力和局限性的平衡观点。通过将先进技术与临床需求相结合,我们提供了红外光谱如何预示着血液疾病诊断的新时代的见解。
    Hematological diseases, due to their complex nature and diverse manifestations, pose significant diagnostic challenges in healthcare. The pressing need for early and accurate diagnosis has driven the exploration of novel diagnostic techniques. Infrared (IR) spectroscopy, renowned for its noninvasive, rapid, and cost-effective characteristics, has emerged as a promising adjunct in hematological diagnostics. This review delves into the transformative role of IR spectroscopy and highlights its applications in detecting and diagnosing various blood-related ailments. We discuss groundbreaking research findings and real-world applications while providing a balanced view of the potential and limitations of the technique. By integrating advanced technology with clinical needs, we offer insights into how IR spectroscopy may herald a new era of hematological disease diagnosis.
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