Immune checkpoint inhibitor-related pneumonitis induced by camrelizumab: a case report and review of literature.

Immune checkpoint inhibitors (ICIs) are new agents that are efficacious in a variety of cancers. However, they are associated with immune-related adverse events due to activated immune system. Among them, checkpoint inhibitor pneumonitis (CIP) deserves more special attentions, because diagnosis and therapy are still challengeable. camrelizumab is a programmed cell death 1 (PD-1) inhibitor that was developed by Jiangsu Hengrui Medicine Co. CIP that is induced by camrelizumab was rarely reported. We described a case that a patient developed CIP 12 days later after one dose of camrelizumab. A 60-year-old man with advanced esophageal squamous cell carcinoma received 6 cycles of Tislelizumab/placebo, capecitabine and cisplatin first. Owing to the poor control of the disease, the patient used Nimotuzumab and docetaxel on April 3, 2020 and April 24, 2020, respectively. Later, he obtained the combination of 200 mg of camrelizumab and 140 mg of docetaxel regimen for once on May 14, 2020. After 12 days, he was diagnosed with CIP in Outpatient. Multiple ground glass opacities were revealed in bilateral lungs from routine CT examination. After giving 40 mg of prednisolone orally once a day, his CIP improved. Meanwhile, camrelizumab was not used again. Teaching point: same as other PD-1 inhibitors, camrelizumab can also cause immune-related pneumonitis. Close observation, regular CT examination and timely corticosteroids intervention are essential.

Frequency and Patterns of Prescribing Antihypertensive Agents in Outpatient Kidney Transplant Recipients Among Six Cities in China from 2011 to 2018.

PURPOSE: Antihypertensive agents are frequently prescribed in kidney transplant recipients (KTRs). However, the frequency and patterns of prescribing antihypertensive agents remain uncharacterized in KTRs in China. Therefore, this investigation was carried out. METHODS: Retrospective prescription data dated 2011 to 2018 from KTRs in China were accessed using the Hospital Prescription Analysis Program database. Information about sex, birth date, and identification number of the patient; city, date, and department of the medical visit; major diagnoses; and the generic names, specifications, quantities, and usage of prescribed drugs were collected. Antihypertensive agents were grouped into 5 classes: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), ß-blockers (BBs), calcium channel blockers (CCBs), and diuretics. The frequency and patterns of prescribing these antihypertensive agents were analyzed. FINDINGS: Prescriptions from 174,749 KTRs (67.2% male; mean age, 42.5 [9.4] years) were obtained, and 58.2% of the patients were prescribed antihypertensive agents. The percentage of patients who received antihypertensive treatment increased from 52.9% in 2011 to 61.6% in 2018 and varied by city. Cyclosporine was associated with higher prescription frequency of antihypertensive agents than was tacrolimus (71.7% vs 63.4%; P < 0.0001). During the 8-year study period, CCBs were most frequently prescribed (39.0%), followed by ARBs (31.9%), BBs (14.3%), ACEIs (11.6%), and diuretics (3.2%). The mean (SD) number of antihypertensive drugs prescribed per KTR was 1.7 (0.8). Almost half of KTRs (51.2%) received just 1 antihypertensive drug. Co-administration of 2 or more antihypertensive drugs presented an obviously upward trend. The most commonly prescribed 2-drug combination was CCB + ARB (44.8%), followed by CCB + BB (20.1%) and CCB + ACEI (13.0%). In the patients who received 3 antihypertensive drugs, the 2 most frequently prescribed combinations were CCB + ARB + BB (37.5%) and CCB + ARB + ACEI (32.7%). Specific data varied by both year and city. IMPLICATIONS: The prescribing patterns of antihypertensive agents in KTRs varied by city even within same country. Hence, more high-quality research studies on the use of antihypertensive agents in KTRs are needed.

Mechanism and effects of fructose diphosphate on anti-hypoxia fatigue and learning memory ability.

This study aims to investigate the mechanisms through which fructose diphosphate (FDP) causes anti-hypoxia and anti-fatigue effects and improves learning and memory. Mice were divided into three groups: low-dose FDP (FDP-L), high-dose FDP (FDP-H), and a control group. Acute toxic hypoxia induced by carbon monoxide, sodium nitrite, and potassium cyanide and acute cerebral ischemic hypoxia were used to investigate the anti-hypoxia ability of FDP. The tests of rod-rotating, mouse tail suspension, and swimming endurance were used to explore the anti-fatigue effects of FDP. The Morris water maze experiment was used to determine the impact of FDP on learning and memory ability. Poisoning-induced hypoxic tests showed that mouse survival time was significantly prolonged in the FDP-L and FDP-H groups compared with the control group (p < 0.05). In the exhaustive swimming test, FDP significantly shortened struggling time and prolonged the time of mass-loaded swimming; the rod-rotating test showed that endurance time was significantly prolonged by using FDP (p < 0.05). FDP significantly decreased lactate and urea nitrogen levels and increased hepatic and muscle glycogen and glucose transporter-4 and Na+-K+-ATPase (p < 0.05). To conclude, FDP enhances hypoxia tolerance and fatigue resistance and improves learning and memory ability through regulating glucose and energy metabolism.

A New System for Whole-atrial Epicardial Mapping.

Epicardial mapping system is an important tool in the study and treatment of cardiac arrhythmias. Surgical therapy has been applied to eliminate atrial fibrillation (AF) for almost two decades, but there is still little effect on the treatment of AF in respect that the mechanism of AF is still unknown. Further investigation into the electrophysiological properties in AF is required to develop an appropriate treatment, though radiofrequency ablation has opened the new era of therapies for AF. Nevertheless, the sequential epicardial mapping for whole-atrium will increase the benefit to understand electrical mechanism during AF. The purpose of our research is to detect the electrical activity on the atrial surface and therefore find the optimal technique or ablation procedures to prevent AF. Animal tests were operated on ten dogs in which chronic AF had been induced. In experiment whole-atrial electrodes were located on the atrial surface after the heart had been exposed. Each 20-second sampling data during sinus or atrial fibrillation rhythm were recorded and stored for analysis. Three-dimensional dynamic maps are presented clearly and the activity of sinus or AF rhythm can be seen quite differently. The active isopotential map can display the dynamic electrical conduction of the atria as a movie. This study demonstrates the flexibility of the system in AF research.

[The application of multilevel B-splines in 3D emulation of dynamic epicardium mapping].

This paper presents an algorithm for data interpolation and approximation used in the whole atria mapping. Multilevel B-splines are introduced to compute the whole atria surface through a set of irregularly spaced points and to draw the 3D isopotential map, which can reflect the conduction process of depolarization in complex arrhythmia such as atrial fibrillation.