Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi最新文献

{"title":"[Chinese expert consensus on prevention and treatment of immunotherapeutic and molecular targeted agents-related infections in patients with hematological malignancies (2025)].","authors":"","doi":"10.3760/cma.j.cn121090-20241114-00451","DOIUrl":"10.3760/cma.j.cn121090-20241114-00451","url":null,"abstract":"<p><p>As novel therapeutic agents continue to emerge, immunotherapy and molecular-targeted drugs demonstrate expanding application prospects in hematological malignancy treatment. This expert consensus revision incorporates the latest evidence-based medicine from domestic and international sources, updating recommendations for infection diagnosis, prevention, and treatment. The document integrates recommendations for recently launched or imminent antibodies and small molecule targeted compounds, including COVID-19 considerations. This format of recommendations is modified according to the levels of evidence of The Oxford Centre for Evidence-Based Medicine (CEBM).</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"18-30"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical characteristics and prognostic analysis of newly diagnosed acute myeloid leukemia with critical illness].","authors":"P Q Liang, M Gao, Y Xie, B Q Li, Q Li, Z Y Liu, D Wang, H Y Qiu, S N Chen, D P Wu, J H Fu","doi":"10.3760/cma.j.cn121090-20241211-00561","DOIUrl":"10.3760/cma.j.cn121090-20241211-00561","url":null,"abstract":"<p><p><b>Objective:</b> This study retrospectively analyzed the clinical characteristics of patients newly diagnosed with acute myeloid leukemia (AML) who were admitted to the hematology intensive care unit (HCU) with critical illness. It also examined factors associated with critical illness and early mortality in these patients. <b>Methods:</b> Clinical data were collected from 91 newly diagnosed AML patients admitted to the HCU of the Department of Hematology, First Affiliated Hospital of Soochow University, from October 2020 to 2024. Reasons for HCU admission, major therapeutic interventions, and risk factors for critical illness and early mortality were analyzed. <b>Results:</b> The median time from diagnosis to HCU admission was 3 days (<i>IQR</i>: 3-9 days), and the median HCU stay was 10 days (<i>IQR</i>: 3-23 days). Of the 91 patients, 71 were admitted to the HCU before induction chemotherapy, while 20 were transferred to the HCU after its initiation. The leading causes of HCU admission were pulmonary infection (78.0% ), respiratory failure (44.0% ), hepatic insufficiency (28.6% ), renal insufficiency (27.5% ), disseminated intravascular coagulation (DIC; 25.3% ), and sepsis (23.1% ). Median Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and SOFA scores at HCU admission were 14 (<i>IQR</i>: 11-18) and the median Sepsis Related Organ Failure Assessment (SOFA) score was 7 (<i>IQR</i>: 4, 10). Major HCU interventions included vasoactive drugs, noninvasive and invasive mechanical ventilation, continuous renal replacement therapy, therapeutic leukocyte clearance, and cardiopulmonary resuscitation. Among patients receiving induction chemotherapy, the composite complete remission rate was 65.4%, and the overall remission rate was 88.5%. Thirty-five (38.5% ) patients died within 28 days of HCU admission. Independent risk factors for 28-day mortality were DIC (<i>OR</i>=9.350, 95% <i>CI</i> 1.999-43.745, <i>P</i>=0.005), sepsis (<i>OR</i>=6.817, 95% <i>CI</i> 1.571-29.582, <i>P</i>=0.010), and cardiac insufficiency (<i>OR</i>=12.281, 95% <i>CI</i> 2.385-63.254, <i>P</i>=0.003) . <b>Conclusion:</b> The main reason for HCU admission in newly diagnosed critically ill AML patients was pulmonary infection. Nearly 40% of patients experisenced early death, and DIC, sepsis, and heart failure were factors influencing early mortatlity.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"39-44"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of risk factors for early death in hyperleukocytic acute leukemia].","authors":"M H Su, Z S Yan, Q L Li, J Y Zhang, Y K Yin, B Hu, Y Z Liu, D P Li, Y C Mi","doi":"10.3760/cma.j.cn121090-20240917-00351","DOIUrl":"10.3760/cma.j.cn121090-20240917-00351","url":null,"abstract":"<p><p><b>Objective:</b> This study analyzed the clinical characteristics and early mortality risk factors in patients with hyperleukocytic acute leukemia (HAL) to provide a basis for predicting early prognosis. <b>Methods:</b> Data were retrospectively collected from 211 patients with primary HAL who visited the Emergency Center of the Hematology Hospital, Chinese Academy of Medical Sciences, between July 1, 2019 and November 30, 2021. The value of each indicator in early risk stratification and prognosis was analyzed. <b>Results:</b> The early-death group exhibited higher WBC, peripheral blood immature cell proportions, prothrombin times (PT), fibrinogen degradation products (FDP), and D-dimer levels than the non-early death group (<i>P</i><0.05). Mortality in hyperleukocytic AML (20.5% ) was significantly higher than that in hyperleukocytic ALL (9.3% ) (<i>P</i><0.05). There were significant differences in age, creatinine, PT, fibrinogen (FIB) levels, WBC, lactic dehydrogenase (LDH), uric acid, blood potassium, blood calcium, and blood phosphorus levels between the two groups of patients (<i>P</i><0.05). A WBC threshold of 255.96×10⁹/L predicted early mortality with 65.6% sensitivity and 69.0% specificity, with higher WBC levels associated with a 5.164-fold increased mortality risk (<i>P</i><0.05). The age, WBC, LDH, urea, PT, FDP and D-dimer of patients at the time of consultation are risk factors affecting the survival of HAL (<i>P</i><0.05) . <b>Conclusion:</b> HAL is a life-threatening condition with a high early mortality. Age, WBC, LDH, urea, PT, FDP and D-dimer are risk factors for early death in HAL.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"46 1","pages":"53-57"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Recovery of enterogenic sepsis-induced disseminated intravascular coagulation after radical surgery for colon cancer: a case report].","authors":"Y N Liu, Y J Liang, J Zhang, X C Ma","doi":"10.3760/cma.j.cn121090-20250104-00006","DOIUrl":"https://doi.org/10.3760/cma.j.cn121090-20250104-00006","url":null,"abstract":"","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"122-124"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Acquired factor Ⅴ inhibitor induced by surgical trauma complicated with fatal hemorrhage: a case report and literature review].","authors":"Y H Zhang, X Pan, X X Chu, W Xu","doi":"10.3760/cma.j.cn121090-20241128-00491","DOIUrl":"10.3760/cma.j.cn121090-20241128-00491","url":null,"abstract":"<p><p><b>Objective:</b> To explore the diagnosis, treatment, and prognosis of patients with acquired factor Ⅴ inhibitors. <b>Methods:</b> We analyzed a case of acquired factor Ⅴ inhibitor treated in the department of critical care medicine at Shanghai East Hospital in 2022. A literature review was conducted using the search terms [ (\"Factor V\" OR \"Factor V Inhibitors\") AND (\"Autoantibodies\" OR \"Immune System Diseases\") ] AND [acquired (Title/Abstract) OR autoimmune (Title/Abstract) OR inhibitor (Title/Abstract) ] in the PubMed database. Chinese databases (Wanfang, VIP, and CNKI) were searched using (acquired factor V inhibitor OR acquired coagulation factor V inhibitor OR coagulation factor V antibody OR coagulation factor V autoantibody) AND (deficiency OR inhibition OR dysfunction) . <b>Results:</b> A 56-year-old male was admitted to the department of critical care medicine due to coagulopathy following surgery. Laboratory tests showed normal blood routine but revealed prolonged PT of 76.7 s, APTT of 83.1 s, and an INR of 7.14. Coagulation factor assays indicated factor V activity at 8.4%, which continued to decline. Immediate and 2-hour delayed mixing studies failed to correct the coagulation abnormalities. The factor V inhibitor titer was measured at 8 BU/ml. It was considered that surgical trauma induced the production of an acquired factor V inhibitor, leading to fatal bleeding. After treatment with corticosteroids, cyclophosphamide, and plasma exchange, the coagulation abnormalities were corrected. The literature search identified 16 cases reported in China and approximately 200 cases reported globally. <b>Conclusion:</b> Patients with acquired factor V inhibitors exhibit diverse clinical manifestations. Current treatment options include combined therapies such as supportive care, corticosteroids, immunosuppressants, and plasma exchange. The prognosis of patients depends on the inducing factors and the timeliness of diagnosis and treatment.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"36-39"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Post-traumatic acquired hemophilia A: a case report and literature review].","authors":"Y Y Xie, M R Yang, M Z Zhang, Z L Deng, L H Wang, J Y Li, J J Zhao, B L Hua, Z Y Yan","doi":"10.3760/cma.j.cn121090-20241223-00581","DOIUrl":"10.3760/cma.j.cn121090-20241223-00581","url":null,"abstract":"<p><p>Acquired Hemophilia A is an acquired bleeding disorder characterized by reduced FⅧ activity due to the presence of autoantibodies against anticoagulant factor Ⅷ in the circulation. Laboratory tests are typically characterized by prolonged isolated activated partial thromboplastin time (APTT). Clinically, it often manifests as severe bleeding, and 50% of AHA patients can identify the cause. This article reports on a patient with post-traumatic AHA who rapidly improved after antibody removal and bypass replacement therapy, followed by wound healing following surgical intervention. A review of relevant literature is also conducted to enhance clinicians' awareness of AHA, which presents with normal coagulation initially and gradually develops into prolonged APTT accompanied by bleeding manifestations, aiming for early diagnosis and timely treatment.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"100-103"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Disseminated intravascular coagulation caused by amniotic fluid embolism: a case report and literature review].","authors":"S F Li, X Xin, J Xiao, W C Ding, J L Wu, S S Wang, S H Chen, L Feng, X G Lin","doi":"10.3760/cma.j.cn121090-20241130-00501","DOIUrl":"10.3760/cma.j.cn121090-20241130-00501","url":null,"abstract":"<p><p>Amniotic fluid embolism (AFE) is a rare but extremely dangerous obstetric catastrophic disease, with coagulation dysfunction being a common clinical manifestation. This article reports a case of AFE with disseminated intravascular coagulation as the initial presentation, and conducts literature review. In order to increase the attention of clinical physicians to obstetric coagulation dysfunction and provide a basis for early identification and treatment of AFE.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"82-84"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Disseminated intravascular coagulation caused by exertional heat stroke: a case report and literature review].","authors":"L Zhang, Z H Zhang, Z Y Sun, X Y Xu, G S Zhou","doi":"10.3760/cma.j.cn121090-20241225-00588","DOIUrl":"10.3760/cma.j.cn121090-20241225-00588","url":null,"abstract":"<p><p><b>Objective:</b> To explore the mechanisms and clinical manifestations of disseminated intravascular coagulation (DIC) caused by exertional heat stroke. <b>Methods:</b> Analyze the clinical data of a patient with exertional heat stroke in Yichang Central People's Hospital and review relevant literature to evaluate the association between heat stroke and DIC, summarizing clinical presentations and laboratory findings. <b>Results:</b> The patient exhibited symptoms such as high fever and altered consciousness after engaging in intense labor in a high-temperature environment. Laboratory tests showed a platelet count of 43×10(9)/L, D-dimer level of 5.3 mg/L, and prothrombin time of 21.8 s, which are consistent with a diagnosis of DIC. Following prompt cooling, fluid resuscitation, appropriate anticoagulant, goal-directed replacement therapy and supportive therapy, the patient's condition gradually improved. <b>Conclusion:</b> Exertional heat stroke can lead to DIC, and clinical attention should be paid to its early recognition and intervention. Effective coagulation management and timely anticoagulant and supportive therapy are crucial for improving prognosis.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"68-72"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cardiac transplantation for recurrent cardiogenic shock following cardiac surgery: a case report].","authors":"T Yang, H Y Ye, H K Liang","doi":"10.3760/cma.j.cn121090-20241130-00506","DOIUrl":"10.3760/cma.j.cn121090-20241130-00506","url":null,"abstract":"<p><p>Heart failure and cardiogenic shock occurred again on the patient who undergone coronary artery bypass grafting, mechanical mitral valve replacement, and tricuspid valve repair surgery for coronary heart disease, mitral regurgitation, and tricuspid valve regurgitation 2 months ago. His heart function could not recover after Intra-Aortic Balloon Pump (IABP) supported for 1 month, and then Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) was applied. During the VA-ECMO assisted procedure, complex coagulation dysfunction was present, bleeding and thrombosis was coexisting. Treatment with anti-infective drugs, adjustment dosage of anticoagulant and anti-infective drugs, and infusion of blood products, coagulation function was improved. Cardiac transplantation was applied after VA-ECMO support for 10 days. Right heart failure, multiple serosal fluid accumulation (in the chest and abdominal cavities), repeated infections in the lungs and blood flow, liver dysfunction, renal dysfunction, coagulation dysfunction, pneumothorax were occurred successively after cardiac transplantation. The patient recovered and discharged from the hospital after active treatment. The recipient's quality of life is good and the transplanted heart function is basically normal.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"114-116"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Immune thrombotic thrombocytopenic purpura treated with Obinutuzumab: a case report and literature review].","authors":"X T Chen, Y Q Zhao, Q Li, H T Li, D D Li, Q Zhang, J Y Fu, D X Lu, D Y Zhang, S J Fan","doi":"10.3760/cma.j.cn121090-20241123-00474","DOIUrl":"10.3760/cma.j.cn121090-20241123-00474","url":null,"abstract":"<p><p><b>Objective:</b> To explore the safety and efficacy of Obinutuzumab in the treatment of immune thrombotic thrombocytopenic purpura. <b>Methods:</b> Data from a case of immune thrombotic thrombocytopenic purpura (iTTP) admitted to the Department of haematology of the First Affiliated Hospital of Harbin Medical University were evaluated retrospectively and a literature review was performed. <b>Results:</b> A 66-year-old female patient was admitted to our hospital for thrombocytopenia. On admission, physical examination showed that yellow skin and sclera. The patient was fully conscious but had a decreasing ability to calculate. Laboratory examination revealed a platelet count of 7×10(9)/L; liver function: alanine aminotransferase 55.2 U/L, azelaic aminotransferase 117.5 U/L; total bilirubin 142.7 μmol/L, direct bilirubin 64.6 μmol/L, indirect bilirubin 78.1 μmol/L; lactate dehydrogenase: 2362 U/L; creatinine: 260.7 μmol/L; peripheral blood smear showed 4% fragmented erythrocytes; ADAMTS13 activity 2.7% and positive inhibitor (1.12 BU). The patient is treated with plasma exchange and glucocorticoids, but the patient's symptoms worsened. Rituximab was permanently discontinued for severe infusion reactions. Treatment with Obinutuzumab (1000 mg, qw×2 w) and she achieved a complete remission for 18 months. The treatment was well tolerated with no adverse events related to Obinutuzumab. <b>Conclusion:</b> For iTTP patients with rituximab intolerance, obinutuzumab is a safe and effective alternative treatment option.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"45 S1","pages":"53-56"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}