Manifestation of severe pneumonia in anti-PL-7 antisynthetase syndrome and B cell lymphoma: A case report.

BACKGROUND: Antisynthetase syndrome (ASS) is characterized by the presence of antisynthetase antibodies coupled with clinical findings such as fever, polymyositis-dermatomyositis and interstitial lung disease. It is, however, rare to observe ASS association with B cell lymphoma presenting severe pneumonia as the first clinical manifestation. CASE SUMMARY: We evaluated a 59-year-old male patient who presented with cough with sputum, shortness of breath and fever for 13 d. A chest computed tomography radiograph revealed bilateral diffuse ground-glass infiltrates in both upper fields, left lingual lobe and right middle lobe. Initially, the patient was diagnosed with severe community-acquired pneumonia and respiratory failure. He was empirically treated with broad-spectrum antibiotics, without improvement. Further analysis showed an ASS panel with anti-PL7 antibodies. Besides, electromyography evaluation demonstrated a manifestation of myogenic damage, while deltoid muscle biopsy showed irregular muscle fiber bundles especially abnormal lymphocyte infiltration. In addition, bone marrow biopsy revealed high invasive B cell lymphoma. Thus, the patient was diagnosed with a relatively rare anti-PL7 antibody positive ASS associated with B cell lymphoma. CONCLUSION: This case highlights that rapidly progressive lung lesions and acute hypoxemic respiratory failure associated with heliotrope rash and extremely high lactate dehydrogenase level should be considered as the characteristics of non-infectious diseases, especially ASS and B cell lymphoma.

Positron imaging for verification of irradiation field during radiotherapy.

AIM OF STUDY: The present study was designed to investigate the application of positron images from photonuclear reactions to verify the location of targeted radiation in vivo. MATERIALS AND METHODS: The phantom study was conducted with distilled water, porcine muscle, porcine adipose tissue, and graphite; these subjects were irradiated separately with 50 MV photons generated by an MM50 Racetrack Microtron. The positron emission activity was measured using a Geiger counter, and the radioactive decay curves for each of the irradiated materials were then established. The positron emission tomography (PET) images of the three tissue models were also achieved using the same radiation conditions. The in vivo PET imaging study was also conducted in tumor-bearing rabbits. RESULTS: Our results demonstrated that the PET imaging could be used to verify the position of the irradiation field in vivo. The dose distribution images of photonuclear reactions of 11 C and 15 O were uniform, using 2-Gy 50 MV photons. CONCLUSIONS: The factors influencing the half-life of radiation activity in various tissues were different from the first order kinetic reaction in physics.

Mannose prevents acute lung injury through mannose receptor pathway and contributes to regulate PPARγ and TGF-ß1 level.

Mannose has been reported to prevent acute lung injury (ALI), and mannose receptor (MR) has been demonstrated to have a role. The rationale for this study is to characterize the mechanism by which mannose and MR prevent lipopolysaccharide (LPS)-induced ALI. Male ICR mice were pretreated mannose by intravenous injection 5 min before and 3 h after intratracheal instillation of LPS. Pathological changes, proinflammatory mediator, peroxisome proliferator activated receptor gamma (PPARγ), MR, and transforming growth factor ß1 (TGF-ß1) levels were determined. The RAW264.7 cells were pretreated with mannose and stimulated with LPS for 3 h. Proinflammatory mediator and TGF-ß1 in the culture media, PPARγ, MR, and TGF-ß1 expression in RAW 264.7 cells were measured. Mannose markedly attenuated the LPS-induced histological alterations and inhibited the production of proinflammatory mediator in mice and in RAW 264.7 cells. Mannose increased PPARγ and MR expression, and inhibited TGF-ß1 stimulated by LPS. Interestingly, competitive inhibition of MR with mannan was associated with elimination of the anti-inflammatory effects of mannose, and reversed effects of mannose of regulation to PPARγ and TGF-ß1. MR is important in increasing PPARγ and decreasing TGF-ß1 expression and plays a critical role in mannose's protection against ALI.

[Effect of "Xinjingjie mouthrinse" on prevention and treatment of radiation-induced oral mucositis].

PURPOSE: To investigate the effect of "Xinjingjie compound lysostaphin antibacterial collutorium" on prevention and treatment of radiation-induced oral mucositis in a prospective, randomized and double-blind clinical trial. METHODS: Sixty patients with oral cancer to be treated with radiotherapy were randomized into the experimental and control group. The experimental group (30 patients) was treated with "Xinjingjie mouthrinse" during the full course of radiotherapy, 4 times daily with 5 mL and 5 min each time. The control group (30 patients) rinsed the mouth in the same way with normal saline. Oral mucositis was assessed according to the RTOG criteria. The severity of mucositis and the degree of pain were recorded and photographed. Patients shouldn't be treated with other drugs until the level of oral mucositis reached above grade III. The results were statistically analyzed using Stata 12.0 software packages. RESULTS: Age, gender, radiotherapy techniques and dose showed no significant difference between the 2 groups (P>0.05). The first onset of oral mucositis in the experimental group was later than that in the control group (11.0 times:9.1 times,P<0.05), and the incidence of pain at the early time of radiotherapy was lower (36.7%: 70.0%, P<0.05). Also, the onset time of grade III oral mucositis in the emperimental group was later than that in the control group (18.9 times:15.9 times,P<0.05), and the incidence of grade III oral mucositis in the experimental group was lower (63.3% vs. 90.0%, P<0.05). CONCLUSIONS: "Xinjingjie mouthrinse" is worthwhile to be used in clinic because it can delay the occurrence time of radiation-induced oral mucositis, alleviate pain and reduce the indication of grade III oral mucositis.

A case of bilateral pleural effusion as the first sign of multiple myeloma.

Multiple myeloma (MM) is a type of hematological malignancy that can affect all types of tissues in human. However, it is extremely rare that pleural effusion presents as the first sign in MM patients. A 54-year-old male patient attended our department of respiratory medicine complaining of shortness of breath for the past 3 months. A chest computer tomography (CT) radiograph revealed a bilateral pleural effusion, which was further assessed as exudative type. Sinus spiral CT scan demonstrated diffuse bone destruction of craniofacial bone. A broad reduction of the lumbar bone signal was confirmed by MRI. Furthermore, pleural biopsy showed abnormal proliferation of plasmocytes whereas bone marrow biopsy showed active hyperplasia of plasmacytoid cells. Interestingly, Bence-Jones protein in urine and serum protein electrophoresis was negative. The patient was diagnosed as non-secretory MM. He then underwent chemotherapy with vincristine, adriamycin and dexamethasone. Partial regression of the pleural effusion was achieved after two rounds of chemotherapy, and the patient has been followed for more than one year.