Pneumonia severity index in the immunocompromised

BACKGROUND

The pneumonia severity index (PSI) accounts for many comorbidities, but not immunosuppression.

OBJECTIVES

To document the utility of the PSI to predict mortality in immunocompromised patients (IP) with community-acquired pneumonia (CAP).

METHODS

Charts of 284 patients with immunosuppression and CAP were reviewed, and these patients were compared with a contemporary sample of non-IP with CAP. The ability of the PSI to predict mortality was assessed by using multiple logistic regression. Discrimination of the PSI was studied by using the concordance index.

RESULTS

Thirty-nine of 284 IP died. Mortality varied according to the etiology of the immunosuppression. Patients with HIV, solid organ transplantation or treatment with immunosuppressive drugs (n=118) had a low in-hospital mortality (4.3%) and were classified as low risk. IP with hematological malignancies, chemotherapy, chest radiation or marrow transplantation (n=166) had a high mortality (20%) and were classified as high risk. Compared with non-IP, low-risk IP had similar PSI-controlled mortality (OR=0.9, P=0.80), whereas high-risk IP had significantly greater mortality (OR=2.8, P<0.0001). The concordance index revealed similar discrimination for the PSI in low-risk IP (0.77) and in non-IP (0.7), but inferior discrimination in high-risk patients (0.6).

CONCLUSIONS

Patients with CAP and immunosuppression can be divided into low-risk and high-risk groups. The low-risk IP have mortality similar to non-IP and can be risk stratified by using the PSI.     

Oral treatment for constitutional delay of growth and puberty in boys: a randomised trial of an anabolic steroid or testosterone undecanoate

Thirty three boys (mean 14.6 years old, range 12.8-16.2 years) with constitutional delay of growth and puberty were randomised into two groups to determine which form of oral treatment would give the better anthropometric response. The two drugs were administered by mouth (one tablet/day) for a mean of 3.5 months (range 3-7 months). At randomisation, 17 boys received testosterone undecanoate (40 mg/day) and 16 oxandrolone (2.5 mg/day). At the start of treatment they were prepubertal or in early puberty, their height SD score was -1.97 in boys treated with testosterone and -2.21 in those treated with oxandrolone, and their growth rates were 4.3 and 4.2 cm/year respectively. Both sex steroid and anabolic steroid treatments induced a significant growth acceleration in all patients except four (three treated with testosterone and one with oxandrolone). When treated with the alternative sex steroid, all four non-responders had a significant anthropometric response. In all boys the induced growth acceleration was sustained when treatment was interrupted. There was no significant difference in the induced growth spurt and bone maturation between the two groups. Spontaneous progress into puberty was achieved in all boys with an increase in testicular volume from a mean of 4.6 to 8.5 ml. The rate of development in secondary sexual characteristics was also similar in the two groups. These data suggest that oral testosterone and oxandrolone are equally effective in the treatment of growth delay in boys with constitutional delay of growth and puberty.     

External versus endoscopic dacryocystorhinostomy: A retrospective study

Background: External dacryocystorhinostomy (DCR) has been the standard surgery for nasolacrimal duct obstruction before the development of endoscopic DCR.     

Risk factors in hospital deaths in severely malnourished children in Kampala, Uganda

Background  

Although the risk factors for increased fatality among severely malnourished children have been reported, recent information from Africa, during a period of HIV pandemic and constrained health services, remains sketchy. The aim of this study has been to establish the risk factors for excess deaths among hospitalized severely malnourished children of below five years of age.     

Macrophage tropism of feline leukemia virus (FeLV) of subgroup-C and increased production of tumor necrosis factor-alpha by FeLV-infected macrophages

Erythroid aplasia is induced in cats by feline leukemia virus (FeLV) of subgroup C but not by FeLV of subgroup A. In an investigation of the role of macrophages in FeLV-C-induced diseases, the concentrations of FeLV and tumor necrosis factor-alpha (TNF-alpha) were compared between feline peritoneal macrophages incubated with FeLV of subgroup A or C. FeLV of both subgroups infected macrophages, but expression of FeLV-C was 21-fold higher than FeLV-A in peritoneal macrophages (P = .004). The supernatants of FeLV-C-inoculated macrophage cultures contained significantly higher levels of TNF-alpha (70 +/- 14 U/mL) at 72 hours postincubation compared with FeLV-A-inoculated (38 +/- 8 U/mL) and uninoculated (31 +/- 8 U/mL) cultures. Moreover, a positive correlation was shown between cell-associated FeLV surface glycoprotein gp70 and TNF-alpha expression in FeLV-C-infected macrophages by immunofluorescence (r = .6; P = .001), measured with a computer- assisted, laser-based digital imaging system. The addition of TNF-alpha to a uniform population of FeLV-infected cells (feline embryonic fibroblasts) caused an enhancement of viral expression (P < .05). These results indicate that FeLV-C has tropism for macrophages, FeLV expression is positively correlated with TNF-alpha expression in macrophages, and TNF-alpha enhances FeLV replication in fibroblasts. We suggest that FeLV-C infection of macrophages and secretion of TNF-alpha may be important in hematopoietic suppression in FeLV-C-infected cats.     

髓核蛋白多糖含量与退行性变腰椎间盘MRI信号强度的相关性

目的:探讨退行性变腰椎间盘MRI信号强度和髓核蛋白多糖含量之间的相关性,评价MRI在椎间盘生化状态评估中的价值。方法:①对象:随机选择的腰椎间盘髓核样本,取自2006-08/2007-01在山东省千佛山医院手术的33例患有腰椎间盘突出症的患者,患者对实验均知情同意。②方法:术前测量腰椎间盘正中矢状面MRIT2WI信号值;术后用紫外分光光度法测量髓核蛋白多糖的含量。③评估指标:对照研究依据Minnatertti法分为Ⅱ类、Ⅲ类腰椎间盘的MRIT2WI信号强度及髓核蛋白多糖含量,并用Pearson相关检验评估两者之间的相关性。结果:Ⅲ类腰椎间盘正中矢状位T2WI信号强度和髓核蛋白多糖含量明显低于Ⅱ类椎间盘(P<0.001),MRIT2WI信号值和髓核蛋白多糖含量之间的相关系数分别为0.674,0.658(P<0.001)。结论:腰椎间盘MRIT2WI信号强度随髓核蛋白多糖含量的减少而降低,二者之间有明显的相关性。MRI是评价椎间盘生化状态的良好工具。     

增强型磷酸钙骨水泥复合材料添加成分的研究现状

目的：总结并分析增强磷酸钙骨水泥复合材料的技术路线及其影响因素,为临床应用提供理论依据。 资料来源：应用计算机检索EI Compendex Web1995-01/2006-12关于增强型磷酸钙骨水泥的文章。检索词“calcium phosphate cement,enforced”并限定文章的语言种类为English。同时利用计算机检索中国期刊全文数据1995-01/2006-12的相关文章,限定文章语言种类为中文,检索词“磷酸钙骨水泥,增强”。 资料选择：对资料进行初审,纳入标准：采用复合方法使磷酸钙骨水泥增强。 资料提炼：共收集到符合上述要求的文献46篇,排除14篇重复性研究。32篇符合纳入标准。 资料综合：磷酸钙骨水泥的复合增强方法主要有添加无机离子、与纤维复合、与大分子物质及有机生物活性物质复合、加入晶须及无机陶瓷颗粒以及同时添加多种组分协同增强。 结论：随着对磷酸钙骨水泥复合材料的深入研究,其机械性能以及其他生物性能必将不断提高与完善,以满足临床需要。     

Identification of a distinct low-affinity receptor for human interleukin-4 on pre-B cells

Biotinylated interleukin-4 (IL-4) was used to examine IL-4 receptor (IL- 4R) expression on a range of human B-cell lines by flow cytometry. Using high concentrations of biotinylated IL-4, we have identified a novel low-affinity IL-4 receptor expressed at high levels on pre-B lines. Expression of this low-affinity receptor did not correlate with detected mRNA levels for the previously cloned receptor or with reactivity of two anti-human IL-4R monoclonal antibodies (MoAb). Radiolabeled IL-4 cross-linking studies using pre-B lines showed a doublet of 65 to 75 Kd in contrast to the 110- to 130-Kd molecule detected on cells expressing the cloned IL-4R. A soluble IL-4 binding protein (IL-4bp) was purified from the supernatants of three pre-B lines expressing the low-affinity receptor on their surface. IL-4bp could block both IL-4-mediated CD23 induction on tonsil B cells and IL- 4-induced inhibition of proliferation of the pre-B line JM1. Partial N- terminal amino acid sequence was obtained from purified IL-4bp that confirmed this protein to be novel. A 12 amino acid peptide based on the IL-4bp sequence was used to produce a polyclonal antiserum that was reactive with purified IL-4bp, and also bound to the surface of pre-B cells but not to murine CTLL cells transfected with the human IL-4R. Blocking MoAb against the previously characterized high-affinity receptor inhibited IL-4-mediated proliferation of hIL-4R+ CTLL cells but had no effect on IL-4-induced inhibition of JM1 cell proliferation, and only partially inhibited IL-4-mediated CD23 and sIgM induction and proliferation of tonsil B cells. The data presented here provide evidence for a novel cell-surface expressed low-affinity IL-4R that also exists as a biologically active soluble IL-4 binding protein.