Pretreatment Absolute Immature Platelet Count is a Promising Predictor of Response to Short-Term Dexamethasone Monotherapy or Combination Therapy in Newly Diagnosed Adult Primary Immune Thrombocytopenia.

Reliable indicators that can predict drug responsiveness in primary immune thrombocytopenia (ITP) patients are urgent. We aimed to establish a reference interval of percentage of immature platelet fraction (IPF%) and absolute immature platelet count (A-IPC), and assess their efficacy in discriminating ITP patients from controls, especially their predictive value for responsiveness to drug treatment. We retrospectively studied 72 treatment-naive adult patients with ITP who received Dexamethasone monotherapy or combination therapy. Baseline (pretreatment) information was collected from medical records. Reference intervals for A-IPC and IPF% were established based on controls and their effectiveness in discriminating ITP patients from controls was assessed. Predictive value of pretreatment IPF% and A-IPC at four co-primary endpoints of treatment response in patients were investigated. The 95% reference intervals for A-IPC and IPF% were (2.7-15.6) × 109/L and 1.2%-7.3%, respectively. Both A-IPC and IPF% had excellent discrimination ability for ITP patients from controls. It showed highly statistically significant differences in pretreatment A-IPC for predicting treatment response at day 7 between responders and non-responders, but not at days 14, 21 and 28. Pretreatment A-IPC had the higher area under the ROC curve with a cut-off of 0.86 than that of IPF% with a cut-off of 14.5% in predicting the treatment response in ITP patients at day 7. Pretreatment A-IPC exhibited acceptable predictive power and could be a promising predictor of response to short-term Dexamethasone monotherapy or combination therapy at day 7 in ITP patients.

Performance comparison of two automated digital morphology analyzers for leukocyte differential in patients with malignant hematological diseases: Mindray MC-80 and Sysmex DI-60.

BACKGROUND: The MC-80 (Mindray, Shenzhen, China), a newly available artificial intelligence (AI)-based digital morphology analyzer, is the focus of this study. We aim to compare the leukocyte differential performance of the Mindray MC-80 with that of the Sysmex DI-60 and the gold standard, manual microscopy. METHODS: A total of 100 abnormal peripheral blood (PB) smears were compared across the MC-80, DI-60, and manual microscopy. Sensitivity, specificity, predictive value, and efficiency were calculated according to the Clinical and Laboratory Standards Institute (CLSI) EP12-A2 guidelines. Comparisons were made using Bland-Altman analysis and Passing-Bablok regression analysis. Additionally, within-run imprecision was evaluated using five samples, each with varying percentages of mature leukocytes and blasts, in accordance with CLSI EP05-A3 guidelines. RESULTS: The within-run coefficient of variation (%CV) of the MC-80 for most cell classes in the five samples was lower than that of the DI-60. Sensitivities for the MC-80 ranged from 98.2% for nucleated red blood cells (NRBC) to 28.6% for reactive lymphocytes. The DI-60's sensitivities varied between 100% for basophils and reactive lymphocytes, and 11.1% for metamyelocytes. Both analyzers demonstrated high specificity, negative predictive value, and efficiency, with over 90% for most cell classes. However, the DI-60 showed relatively lower specificity for lymphocytes (73.2%) and lower efficiency for blasts and lymphocytes (80.1% and 78.6%, respectively) compared with the MC-80. Bland-Altman analysis indicated that the absolute mean differences (%) ranged from 0.01 to 4.57 in MC-80 versus manual differential and 0.01 to 3.39 in DI-60 versus manual differential. After verification by technicians, both analyzers exhibited a very high correlation (r = 0.90-1.00) with the manual differential results in neutrophils, lymphocytes, and blasts. CONCLUSIONS: The Mindray MC-80 demonstrated good performance for leukocyte differential in PB smears, notably exhibiting higher sensitivity for blasts identification than the DI-60.

Sulperazon-induced acute reactive thrombocytopenia during treatment of systemic lupus erythematosus: a case report.

The purpose of this study is to report a patient who developed acute reactive thrombocytopenia while undergoing treatment with sulperazon for systemic lupus erythematosus (SLE). Sulperazon is a broad-spectrum antibiotic that can act against a wide range of microorganisms, but rarely causes severe thrombocytopenic events. We describe a 62-year-old man with new-onset acute reactive thrombocytopenia who experienced a precipitous fall in the platelet count from 168×109/L to 1×109/L within 29 hours after exposure to sulperazon. Sulperazon was immediately discontinued followed by administration of intravenous immunoglobulin for six consecutive days. The platelet count eventually recovered and petechiae at the injection sites improved. No complications secondary to acute reactive thrombocytopenia were observed except petechiae.

HBcrAg, pg RNA and HBsAg dynamically supervise the seroconversion of HBsAg with anti-viral therapy: "Loss of HBsAg" maybe not a good end-point of anti-viral therapy.

OBJECTIVE: We aimed to identify predictor of HBsAg seroconversion using serum quantitative pg-RNA, HBcrAg and HBsAg in CHB patients with anti-viral therapy. METHOD: A total of 335 patients with anti-viral therapy between 2013 and 2017 were enrolled, only 23 achieved the seroconversion of HBsAg, other 138 patients without seroconversion of HBsAg were selected randomly in 312 patients. The samples date of 161 patients were analyzed at different time. We defined the decrease titer of pg-RNA, HBcrAg and HBsAg from baseline to 6 months and baseline to 12 months as Δpg-RNA, ΔHBcrAg and ΔHBsAg, then we used the Δpg-RNA, ΔHBcrAg and ΔHBsAg to predict HBsAg seroconversion. RESULT: About 6.9% of patients achieved HBsAg seroconversion after a median of 3.61 years' treatment. Using ROC to predict seroconversion of HBsAg, ΔHBsAg of 0.64 log10 IU/mL with AUC of 0.886 (0.802, 0.969; 95% CI) at 6 months and ΔHBsAg of 1.45 log10 IU/mL with AUC of 0.939 (0.868, 1.000; 95% CI) at 12 months had the maximized Youden's index. The comparison of HBcrAg "conversion" rates using Kaplan-Meier method between 23 patients with HBsAg conversion and 138 patients with HBsAg no conversion indicated that the two groups had significant difference at the time of antiviral discontinuation (p = 0.0124). CONCLUSION: According to our results, we can use ΔHBsAg to pick out the appropriate patients who have the potential to achieve seroconversion by sticking to antiviral therapy, that is very important to reach the target of functional cure or even clinical cure.

Serology, virulence and molecular characteristics of Vibrio parahaemolyticus isolated from seafood in Zhejiang province.

Vibrio parahaemolyticus is a leading foodborne pathogen in southeastern China. In this study, 105 strains of V. parahaemolyticus were isolated from fresh seafood in 2013 and 2014. The serotypes, virulence-associated genes and sequence types (STs) of these strains were analyzed. 26 defined serotypes were identified and 69 strains (65.7%) had untypeable O or K antigen. 8 strains (7.6%) had the virulence-associated gene tdh and no strain carried the trh gene. 45.7% (48/105) of isolates contained all four T3SS1 genes and 50% (4/8) tdh+ trh- V. parahaemolyticus isolates lacked at least one of the four tested T3SS2α genes. 105 strains could be categorized into 84 STs and only 3 STs (ST3, ST8, ST675) had appeared in clinical strains. V. parahaemolyticus strains from seafood have more diverse and untypeable serotypes, less virulence-associated genes and more STs than strains from clinical sources.

Benefit of Early Initiation of Neuraminidase Inhibitor Treatment to Hospitalized Patients With Avian Influenza A(H7N9) Virus.

Background: The significance of early neuraminidase inhibitor (NAI) therapy for treating influenza A(H7N9) is currently unknown. Methods: The duration of viral shedding was monitored by reverse-transcription polymerase chain reaction after patients with confirmed H7N9 infection were admitted to the First Affiliated Hospital, Zhejiang University, during April 2013-April 2017. Indices such as the length of hospitalization and mortality were collected, and the correlation between the time of administration of NAI and the severity of disease was systematically analyzed. Results: One hundred sixty patients with confirmed H7N9 infection were divided into 3 groups according to NAI starting time. Three of 20 (15%) patients for whom NAI was administered within 2 days died compared with 12 of 52 (23.1%) patients who received treatment within 2-5 days and 33 of 88 (37.5%) patients who were treated after 5 days (P < .05). The median durations of viral shedding from NAI therapy initiation was 4.5 days (interquartile range [IQR], 3-9 days) for patients who took antiviral medication within 2 days, which was significantly different from that for patients who took medication within 2-5 days (7.5 days [IQR, 4.25-12.75 days]) or after 5 days (7 days [IQR, 5-10 days]) (P < .05). We found that the duration of viral shedding from NAI therapy was the shortest in spring 2013 (5.5 days) and the longest in winter-spring 2016-2017 (8.5 days) (P < .05), showing a prolonged trend. Conclusions: Early NAI therapy within 2 days of illness shortened the duration of viral shedding and improved survival in patients with H7N9 viral infection.

Etiology of diarrhea among children under the age five in China: Results from a five-year surveillance.

OBJECTIVES: Diarrhea is a leading cause of morbidity and mortality for children, although sparse data is available on the etiology of diarrhea in China. This study was conducted to determine main causes that underlie childhood diarrhea and related diseases. METHOD: Surveillance data for diarrhea was collected from 213 participating hospitals between 2009 and 2013. These stool specimens, from children aged 0-59 months, were then analyzed for a panel of etiological agents consisting of 5 viruses, 8 bacteria and 3 protozoa. The proportion of children who tested positive for each pathogen was calculated and seasonal patterns for major organisms were determined. RESULTS: Pathogens were identified in 44.6% of the 32,189 samples from children with diarrhea. The most commonly detected pathogens were rotavirus (29.7% of cases), norovirus (11.8%), Diarrheagenic Escherichia coli (DEC; 5.0%), adenovirus (4.8%), non-typhoidal Salmonella (NTS; 4.3%), and Shigella spp. (3.6%). A strong seasonal pattern was observed for these organisms, including rotavirus (winter), norovirus (autumn), and DEC, NTS, and Shigella (summer). CONCLUSION: A wide range of enteropathogens were detected in this five-year surveillance study; rotavirus and norovirus were most common among children under the age five. These findings should serve as robust evidence for public health entities when planning and developing national intervention programs in China.

[Viral etiologies of hospitalized pneumonia patients aged less than five years in six provinces, 2009-2012].

OBJECTIVE: To analyze the viral etiologies of hospitalized pneumonia patients aged less than five years in six provinces during 2009-2012, and to describe the seasonality of the detected viral etiologies. METHODS: Eight hospitals were selected in six provinces from a national acute respiratory infection surveillance network. Demographic information, clinical history and physical examination, and laboratory testing results of the enrolled hospitalized patients aged less than five years with pneumonia, including respiratory syncytial virus (RSV), human influenza virus, adenoviruses (ADV), human parainfluenza virus (PIV), human metapneumovirus (hMPV), human coronavirus (hCoV)and human bocavirus (hBoV) were analyzed. The viral etiology spectrum of the enrolled patients was analyzed by age-group, year, and seasonality of the detected viral etiologies were described. RESULTS: 4 508 hospitalized children less than five years old, with pneumonia from 8 hospitals were included, and 2 688 (59.6%) patients were positive for at least one viral etiology. The most frequent detected virus was RSV (21.3%), followed by PIV (7.1%) and influenza (5.2%), hBoV (3.8%), ADV(3.6%) and hMPV(2.6%). The lowest positive rates in hCoV(1.1%). RSV, influenza, PIV, hBoV and hMPV all showed the nature of seasonality. CONCLUSION: RSV was a most common viral etiology in the hospitalized young children less than 5 years of age with pneumonia. Prevention measures should be conducted to decrease its severe impact to the young infants and children in China.

Increased frequency of circulating follicular helper T cells in children with hand, foot, and mouth disease caused by enterovirus 71 infection.

Enterovirus 71 (EV71) is a major causative agent of hand, foot, and mouth disease (HFMD) in children. The role of T follicular helper (TFH) cells in EV71-infected children remains unclear in regulating humoral immunity. The frequency of circulating ICOS(high)/PD-1(high)CXCR5(+)CD4(+) TFH cells in the children with mild and severe EV71 infection and healthy controls (HC) was detected by flow cytometry, respectively. IL-21 and IL-6 mRNA expression and their serum levels, Bcl-6 mRNA expression, and specific neutralizing antibodies against EV71 (NAb-EV71) were measured. In the acute stage of patients with EV71 infection, increased frequencies of circulating TFH cells with ICOS(high) and PD-1(high) expression in the mild and severe patients were observed, and the positive correlations among the frequencies of circulating TFH cells and the serum levels of IL-21, IL-6, and NAb-EV71 titres were detected, respectively. Moreover, the expressions of IL-6 and IL-21 mRNA in PBMCs from patients were also significantly higher than those of HC. However, further analysis did not reveal any significant differences between mild and severe patients. These data indicate a role of TFH cells and associated cytokines in modulating the humoral response during the pathogenesis of EV71 infection.

Viral etiologies of hospitalized acute lower respiratory infection patients in China, 2009-2013.

BACKGROUND: Acute lower respiratory infections (ALRIs) are an important cause of acute illnesses and mortality worldwide and in China. However, a large-scale study on the prevalence of viral infections across multiple provinces and seasons has not been previously reported from China. Here, we aimed to identify the viral etiologies associated with ALRIs from 22 Chinese provinces. METHODS AND FINDINGS: Active surveillance for hospitalized ALRI patients in 108 sentinel hospitals in 24 provinces of China was conducted from January 2009-September 2013. We enrolled hospitalized all-age patients with ALRI, and collected respiratory specimens, blood or serum collected for diagnostic testing for respiratory syncytial virus (RSV), human influenza virus, adenoviruses (ADV), human parainfluenza virus (PIV), human metapneumovirus (hMPV), human coronavirus (hCoV) and human bocavirus (hBoV). We included 28,369 ALRI patients from 81 (of the 108) sentinel hospitals in 22 (of the 24) provinces, and 10,387 (36.6%) were positive for at least one etiology. The most frequently detected virus was RSV (9.9%), followed by influenza (6.6%), PIV (4.8%), ADV (3.4%), hBoV (1.9), hMPV (1.5%) and hCoV (1.4%). Co-detections were found in 7.2% of patients. RSV was the most common etiology (17.0%) in young children aged <2 years. Influenza viruses were the main cause of the ALRIs in adults and elderly. PIV, hBoV, hMPV and ADV infections were more frequent in children, while hCoV infection was distributed evenly in all-age. There were clear seasonal peaks for RSV, influenza, PIV, hBoV and hMPV infections. CONCLUSIONS: Our findings could serve as robust evidence for public health authorities in drawing up further plans to prevent and control ALRIs associated with viral pathogens. RSV is common in young children and prevention measures could have large public health impact. Influenza was most common in adults and influenza vaccination should be implemented on a wider scale in China.

[Analysis of effect on infectious diseases outbreak detection performance by classifying provinces for moving percentile method].

OBJECTIVE: Providing evidences for further modification of China Infectious Diseases Automated-alert and Response System (CIDARS) via analyzing the outbreak detection performance of Moving Percentile Method (MPM) by optimizing thresholds in different provinces. METHODS: We collected the amount of MPM signals, response results of signals in CIDARS, cases data in nationwide Notifiable Infectious Diseases Reporting Information System, and outbreaks data in Public Health Emergency Reporting System of 16 infectious diseases in 31 provinces in Chinese mainland from January 2011 to October 2013. The threshold with the optimal sensitivity, the shortest time to detect outbreak and the least number of signals was considered as the best threshold of each disease in Chinese mainland and in each province. RESULTS: Among all the 16 diseases, the optimal thresholds of 10 diseases, including dysentery, dengue, hepatitis A, typhoid and paratyphoid, meningococcal meningitis, Japanese encephalitis, scarlet fever, leptospirosis, hepatitis, typhus in country level were the 90(th) percentile (P90), which was the same as provincial level for those diseases.For the other 6 diseases, including other infectious diarrhea, influenza, acute hemorrhagic conjunctivitis, mumps, rubella and epidemic hemorrhagic fever, the nationwide optimal thresholds were the 80th percentile (P80), which was different from that by provinces for each disease. For these 6 diseases, the number of signals generated by MPM with the optimal threshold for each province was decreased by 23.71% (45 557), 15.59% (6 124), 14.07% (1 870), 9.44% (13 881), 8.65% (1 294) and 6.03% (313) respectively, comparing to the national optimal threshold, while the sensitivity and time to detection of CIDARS were still the same. CONCLUSION: Optimizing the threshold by different diseases and provinces for MPM in CIDARS could reduce the number of signals while maintaining the same sensitivity and time to detection.

Correlation of hepatitis B surface antigen level with response to telbivudine in naive patients with chronic hepatitis B.

AIM: Hepatitis B surface antigen (HBsAg) has become a marker to judge immunological response to hepatitis B therapy. Quantified serum HBsAg levels can predict the response to pegylated interferon and entecavir. In this study, we aimed to explore the correlation of serum HBsAg levels with response to telbivudine (LdT) treatment in patients with chronic hepatitis B (CHB). METHODS: Seventy-three treatment-naive CHB patients were recruited and received LdT monotherapy for 52 weeks and serial HBsAg levels were measured at five protocol time points. According to therapeutic efficacy at week 52, three subgroups of patients were identified, including complete responders (CR), partial responders (PR) and non-responders (NR). RESULTS: After 52 weeks of treatment, CR, PR and NR represented 19 (26%), 33 (45%) and 21 (29%) patients in the sample of 73, respectively. The median values of baseline HBsAg (log10 IU/mL) were 4.05, 4.50 and 5.03 for CR, PR and NR, respectively. There was a distinct decline of HBsAg at week 52; median log10 HBsAg levels (IU/mL) were 3.61 (CR), 3.86 (PR) and 4.31 (NR). Positive correlation between HBsAg levels and HBV DNA loads was observed in the group of NR and early antiviral treatment of PR, but not in CR. CONCLUSION: Initial HBsAg level was closely correlated with the efficacy of LdT. Patients with low HBsAg levels presented satisfactory responses. Therefore, initial level and correlation with HBV DNA of the serum HBsAg levels could predict responsiveness in CHB patients receiving LdT.