Lenalidomide plus dexamethasone for proliferative glomerulonephritis with monoclonal immunoglobulin deposits

Objective To evaluate the efficacy and safety of lenalidomide plus dexamethasone (LD) in patients with proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID). Methods The clinicopathological data of PGNMID patients who were treated with LD protocol from January 2010 to October 2019 were retrospectively analyzed. Results All of 6 patients received LD treatment for≥3 months after renal biopsy in Jinling Hospital. During the follow-up period of 6 to 19 months, 3 patients achieved renal remission, and the renal remission rate was 50%(3/6). Light microscopy showed membranoproliferative glomerulonephritis and immunofluorescence showed single kappa type IgG3 was deposited in the mesangial region and the vascular loop. Before taking LD scheme, the median urinary protein were 7.76(1.27, 14.57) g/24 h, the median serum creatinine was 118.5(70.7, 289.1) μmol/L, and the median albumin was 34.5(22.4, 37.5) g/L. The concentration of serum free kappa and lambda light chain was increased in 5 patients, but the serum free light chain ratio was normal. Hypocomplementemia was detected in two cases. Six patients underwent bone marrow flow cytometry, and 2 patients had elevated monoclonal plasma cells, accounting for 0.7% and 0.5%, respectively. Immunofixation electrophoresis suggested that 1 patient had positive serum M protein for kappa type IgG3. At the last follow-up, median urine protein was 3.33(0.33, 11.23) g/24 h, median serum creatinine was 108.7(80.4, 160.9) μmol/L, and median albumin was 35.9(24.5, 45.6) g/L. The concentration of serum free light chain in 4 patients from 5 patients with elevated serum free light chain was lower than that before taking the drug. Decreased level of serum complement in two cases returned to normal after treatment. The M spike did not turn negative during the follow-up in one patient. Adverse events included anemia, neutropenia, limb numbness and upper respiratory tract infection. Conclusion This study reports for the first time that LD protocol may be effective in treating PGNMID, but more attention should be paid to the hematological adverse events of lenalidomide.     

特异性IgY抗体对人牙菌斑中变形链球菌的影响

目的:研究抗变形链球菌葡糖基转移酶过表达株IgY抗体对人牙菌斑中变形链球菌的影响。方法:采用双盲法,选择自愿受试者41名,分为对照组和试验组两组。分别给予含抗变形链球菌葡糖基转移酶过表达株IgY抗体和非特异性IgY抗体的喷雾剂,每日两次,共4周。试验前、试验后1周、试验后4周分别取口腔内指定牙位的菌斑样本,在厌氧的环境中培养,检测变形链球菌菌落数及总厌氧菌菌落数,并计算变形链球菌占总厌氧菌的百分率。结果:使用抗变形链球菌葡糖基转移酶过表达株IgY抗体1周及4周变形链球菌计数较试验前有显著性减少,变形链球菌占总厌氧菌的百分率分别降低12.99%和12.70%,而对照组中的变形链球菌计数和变形链球菌占总厌氧菌的百分率试验前后无显著性差异。结论:抗变形链球菌葡糖基转移酶过表达株IgY抗体可明显减少人牙菌斑中的变形链球菌,改变人牙菌斑的微生物组成,可为防龋提供新的思路。     

含抗变形链球菌IgY抗体的溶液对菌斑的作用

目的　观察含 0 1%抗变形链球菌IgY抗体的溶液对变形链球菌及菌斑量的作用效果。方法　采用双盲法 ,试验组 4 4名小学三年级学生使用含IgY抗体的溶液 2 1d ,对照组 4 1人使用安慰剂。试验前后对所有学生的菌斑指数、菌斑量、唾液和菌斑中的变形链球菌进行了检测。结果　试验组学生试验前的菌斑重量是 (46 4± 31 2 )mg ,试验后的菌斑重量是 (36 6± 2 5 6 )mg ,试验前后的差异有极显著性 (P =0 0 0 7) ,与试验前相比菌斑量减少了 2 1 1%。对照组学生的菌斑重量在试验前后分别是 (45 0± 2 3 8)mg和 (41 2± 2 5 9)mg ,二者差异无显著性 (P =0 2 86 )。唾液和菌斑中的变形链球菌量没有显著变化。结论　含 0 1%抗变形链球菌IgY抗体的溶液有减少菌斑形成的作用。     

大剂量丙种球蛋白辅助治疗成人重症病毒性肺炎临床效果的Meta分析

背景　近年来,病毒性肺炎患病率较高,尤其是流感所致的重症肺炎具有高死亡率,已有研究表明静脉滴注免疫球蛋白可辅助治疗重症肺炎,但是仅有散在研究及案例报道,缺乏系统的临床疗效评价。目的　评价静脉滴注大剂量丙种球蛋白（IVIG）辅助治疗成人重症病毒性肺炎的临床疗效。方法　检索PubMed、EMBase、Web of Science、The Cochrane Library、中国知网、万方数据知识服务平台、中国生物医学文献数据库、维普网中关于两种治疗方案临床疗效对比的随机对照研究,检索时间为建库至2020-03-05。对纳入研究的文献进行质量评价和数据提取,收集患者的临床有效率、C反应蛋白（CRP）、CD4+、CD4+/CD8+、白介素2（IL-2）、不良反应发生率等指标,并进行Meta分析。结果　共纳入9篇文献,1 021例患者,文献质量等级均为B。Meta分析结果显示,试验组临床有效率〔RR=1.24,95%CI（1.18,1.31）,P<0.000 01〕、CD4+水平〔MD=10.05,95%CI（9.19,10.90）,P<0.000 01〕,CD4+/CD8+〔MD=0.75,95%CI（0.68,0.82）,P<0.000 01〕〕高于对照组,治疗后CRP水平〔MD=-3.64,95%CI（-4.23,-3.05）,P<0.000 01〕、IL-2水平〔MD=0.61,95%CI（0.45,0.77）,P<0.000 01〕、不良反应发生率〔RR=0.30,95%CI（0.16,0.55）,P<0.000 01〕低于对照组。结论　静脉滴注大剂量IVIG能改善成人重症病毒性肺炎的临床结局。     

补肾活血散瘀汤联合高强度聚焦超声对子宫腺肌病的疗效及病人免疫功能的影响

目的探究补肾活血散瘀汤联合高强度聚焦超声对子宫腺肌病的疗效及病人免疫功能的影响。方法选取 2020年 7—12月石家庄市人民医院收治的 110例子宫腺肌病病人,按随机数字表法分为超声组( 55例)和联合组( 55例)。其中超声组给予高强度聚焦超声治疗,联合组给予补肾活血散瘀汤联合高强度聚焦超声治疗子宫腺肌病病人。比较两组病人免疫功能［补体 C3、C4、免疫球蛋白 A(IgA)、免疫球蛋白 G(IgG)、免疫球蛋白 M(IgM)］,月经改善情况(月经量、疼痛程度)中医症候积分,血清糖类抗原 CA125水平、子宫体积及不良反应发生情况。结果与治疗前比较,两组治疗后补体 C3［联合,组( 95.32±2.12)比( 102.74±3.42)mg/dL、超声组( 98.12±2.58)比( 101.89±3.36)mg/dL］、 IgA水平［联合组( 2.42±0.26)比( 3.47±0.46)mg/dL、超声组( 3.01±0.34)比( 3.54±0.51)g/L］、月经量评分、疼痛视觉模拟评分法( VAS评分)、中医症候积分、血清糖类抗原 CA125水平、子宫体积明显降低( P<0.05)且与超声组比较,联合组明显降低( P<0.05);两组血清 IgG［联合组( 15.78±1.67)比( 12.12±1.14)g/L、超声组( 13.78±1.42)比.35±1.21)g/L］明显升高( P<0.05),且与超声组比较,联合组明显升高( P<0.05)两组不良反应发生率比较差异无统计学意义( P>0.05)。结论补肾活血散瘀汤联合高强度聚焦超声治疗子宫腺肌病病人可有效改善临(12,床症状,提高免疫功能,安全有效。     

Vitamin D deficiency in children with recurrent respiratory infections,with or without immunoglobulin deficiency

Purpose

The objective of this study was to evaluate thevitamin D concentration in patients with recurrent respiratory infections with or without immunoglobulin G, A or M (IgG, IgA, IgM) deficiency, and to find a correlation between the vitamin D concentration and the response to hepatitis B vaccination.

Intravenous Immunoglobulins as a new opportunity to treat discoid lupus erythematosus: A case report and review of the literature

Discoid lupus erythematosus (DLE) is a chronic dermatological disease that can lead to scarring, alopecia and dyspigmentation, if not properly treated. Actually, no drugs are specifically approved for the treatment of CLE, although the first-line therapy usually consists of photoprotection associated to topical or oral steroids, topical calcineurin inhibitors and hydroxychloroquine (HCQ). In cases of DLE refractory to these medications, many other agents have been employed, such as dapsone, methotrexate, azathioprine, cyclophosphamide, biologic drugs and Intravenous Immunoglobulin (IVIG).We described the case of a DLE patient resistant to combination therapy with steroid and HCQ who was successfully treated with cyclical IVIG therapy. The treatment with IVIG resulted rapidly effective with persistent efficacy and low rates of relapses, although more cycles of IVIG are needed to achieve a stable clinical remission.We also discussed the beneficial and promising effects of IVIG in patients with Cutaneous Lupus reporting the previously published data.     

Rabies vaccines: WHO position paper,April 2018 – Recommendations

This article presented the World Health Organization’s (WHO) recommendations on the use of Rabies vaccines excerpted from the Rabies vaccines: WHO position paper – April 2018 published in the Weekly Epidemiological Record [1] This position paper replaces the 2010 WHO position paper on rabies vaccines [2]. It presents new evidence in the field of rabies and the use of rabies vaccines, focussing on programmatic feasibility, simplification of vaccination schedules and improved cost-effectiveness. The recommendations concern the 2 main immunization strategies, namely vaccination for post-exposure prophylaxis and vaccination for pre-exposure prophylaxis. In the context of post-exposure prophylaxis, recommendations are also provided on the use of rabies immunoglobulins.Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation tables. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO’s current position on the use of vaccines in the global context. Recommendations on the use of cholera vaccines were discussed by the Strategic Advisory Group of Experts (SAGE) in October 2017; evidence presented at these meetings can be accessed at:http://www.who.int/immunization/sage/meetings/2017/october/presentations_background_docs/en/.     

TT Virus Infection in Patients with Primary Hypogammaglobulinaemia: Natural History and Relationship to Liver Disease in the Immunocompromised Host

Background: TT virus (TTV) is a recently discovered human DNA virus with worldwide distribution, but with no clear disease association. The possibility of an enhanced TTV virulence in patients with immunodeficiencies has not yet been investigated but is of particular interest because other viruses have been demonstrated to cause severe and rapid liver disease in such patients. Here we analysed the characteristics of TTV infection in a large cohort of patients with primary hypogammaglobulinaemia (PHG) and whether TTV has a role in the frequently observed cryptogenic liver disease in these patients. Methods: 83 Norwegian patients with PHG (serum immunoglobulin G _&lt; 2 g/L), receiving substitution treatment with immunoglobulins, were followed regularly for median 10.2 years (range 2-30). TTV DNA was sought in serum samples and three immunoglobulin preparations by polymerase chain reaction; TTV DNA quantitation, DNA sequencing and phylogenetic analysis were performed in selected samples. Results: TTV DNA was detected in 27 of 83 (32.5%) patients and was not associated with a particular type of PHG. The prevalence of TTV infection was dependent on intravenous immunoglobulin administration, duration of therapy and patient's age. TTV DNA was found in two of three currently used immunoglobulin preparations. In the longitudinal study, whether TTV was cleared or newly acquired had no impact on liver function tests and no particular TTV strain was found in patients with more severe liver disease. Conclusions: TTV infection is common in patients with PHG. Treatment with immunoglobulins has a role in the transmission of TTV in these patients. However, we found no evidence of TTV-induced liver disease in this group of immunocompromised patients.